Platelet-rich Plasma Infiltration Research Articles

9. Chronic knee pain.

Chronic knee pain is defined as pain that persists or recurs over 3 months. The most common is degenerative osteoarthritis (OA). This review represents a comprehensive description of the pathology, diagnosis, and treatment of OA of the knee. The literature on the diagnosis and treatment of chronic knee pain was retrieved and summarized. A modified Delphi approach was used to formulate recommendations on interventional treatments. Patients with knee OA commonly present with insidious, chronic knee pain that gradually worsens. Pain caused by knee OA is predominantly nociceptive pain, with occasional nociplastic and infrequent neuropathic characteristics occurring in a diseased knee. A standard musculoskeletal and neurological examination is required for the diagnosis of knee OA. Although typical clinical OA findings are sufficient for diagnosis, medical imaging may be performed to improve specificity. The differential diagnosis should exclude other causes of knee pain including bone and joint disorders such as rheumatoid arthritis, spondylo- and other arthropathies, and infections. When conservative treatment fails, intra-articular injections of corticosteroids and radiofrequency (conventional and cooled) of the genicular nerves have been shown to be effective. Hyaluronic acid infiltrations are conditionally recommended. Platelet-rich plasma infiltrations, chemical ablation of genicular nerves, and neurostimulation have, at the moment, not enough evidence and can be considered in a study setting. The decision to perform joint-preserving and joint-replacement options should be made multidisciplinary. When conservative measures fail to provide satisfactory pain relief, a multidisciplinary approach is recommended including psychological therapy, integrative treatments, and procedural options such as intra-articular injections, radiofrequency ablation, and surgery.

The Analysis Study of The Effect of Intraosseus Infiltration of Platelet Rich Plasma for Knee Osteoarthritis : A Comprehensive Systematic Review

Background: Knee osteoarthritis (KOA) is an active, heterogeneous, and low-grade inflammatory condition leading to functional disability and pain. The aim: The aim of this study to show about the effect of intraosseus infiltration of platelet rich plasma for knee osteorthritis. Methods: By the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020, this study was able to show that it met all of the requirements. Result: Eight publications were found to be directly related to our ongoing systematic examination after a rigorous three-level screening approach. Subsequently, a comprehensive analysis of the complete text was conducted, and additional scrutiny was given to these articles. Conclusion: Intraosseous (IO) PRP injections to target subchondral bone can provide a more comprehensive treatment by stimulating biological processes that lead to an environment primed for regeneration. Restoring joint homeostasis also influences the behaviour of MSCs that coordinate bone remodelling of the subchondral bone.

The Efficacy of Intra-articular Platelet-Rich Plasma Injection Versus Corticosteroid Injection in the Treatment of Knee Osteoarthritis: A Prospective Comparative Analysis.

Background Knee osteoarthritis (KOA) is the most typical cause of knee pain and impairment worldwide. It is typified by slow and progressive degeneration of the articular cartilage of the knee joint. Although KOA is being managed with a variety of therapies, the comparison of the effectiveness of different intra-articular injections in KOA treatment in Pakistan is still not thoroughly investigated. Therefore, the purpose of this current study is to compare the efficacy of intra-articular administration of platelet-rich plasma (PRP) and corticosteroids (CSs) in the treatment of KOA. Methods This prospective comparative study was performed among one hundred patients diagnosed with KOA in Benazir Bhutto Hospital, Rawalpindi, for one year from April 2022 to March 2023. Specified inclusion and exclusion criteria were employed for patient enrollment. Patients were divided into two equal groups through simple random sampling. Group A patients received an intra-articular injection of PRP solution whereas group B patients received an intra-articular injection of CSs. Informed consent and ethical approval were also acquired prior to data collection. A self-designed proforma based on interviews was used to collect data. The data analysis in Statistical Package for the Social Sciences (IBM SPSS Statistics for Windows, IBM Corp., Version 25.0, Armonk, NY) was carried out via descriptive statistics and an independent t-test. Results Women (N=71, 71%) had a higher prevalence of KOA than men (N=29, 29%). The means of study variables like age, Visual Analog Scale (VAS) score, and Western Ontario and McMaster Universities (WOMAC) score were 56.10 ± 8.70 years, 8.08 ± 1.6, and 70.08 ± 8.76 respectively. The frequency of KOA on the right side was 62% (N=62) while it was 38% (N=38) on the left side. In the study population,69% (N=69) patients had grade II KOA, and 31% (N=31) patients had grade III KOA. At the first-month, second-month, and third-month follow-up visits, there were statistically significant differences in the mean scores of the WOMAC and VAS between the study groups. However, at the first-month follow-up visit, mean scores of VAS and WOMAC were lower in group B than in group A while these were lower in group A as compared to group B, at the second-month and third-month follow-up appointments. Conclusions Intra-articular infiltration of both PRP and CSs was efficacious in the treatment of KOA-related pain and functional limitations; however, overall improvement in the PRP group was higher than CSgroup.

Efficacy and Safety of Platelet-Rich Plasma Injection for Chronic Plantar Fasciitis: A Prospective Study on Functional Restoration and Pain Relief.

Background Heel discomfort and functional impairment are frequently caused by plantar fasciitis, and treating it can be extremely difficult for clinicians and occasionally have unfavorable clinical consequences. Recently, platelet-rich plasma (PRP) has been used as an alternative therapy for plantar fasciitis (PF) to reduce heel pain and improve functional restoration. We evaluated the current evidence concerning the efficacy and safety of PRP as a treatment for PF. Methodology This was a hospital-based prospective study on patients with plantar fasciitis with a symptom duration of six months or more with failed conservative therapy. All patients included in the study were assessed clinically and by a visual analog score (VAS) for heel pain, the Ankle-Hindfoot Scale (AHS) component of the American Orthopedic Foot and Ankle Society (AOFAS) and Foot and Ankle Ability Measure (FAAM) scores before injection, and at three weeks, three and six-months post-PRP treatment follow-up. Ultrasonography (USG) measurement of plantar fascia thickness was done pre-injection and at the six-month follow-up for clinical outcomes and any complications. Results The study included 25 patients with plantar fasciitis, with the majority (48%) in the age group of 21-30 years. Females accounted for 64% of the patientswhile males accounted for 36%. Most patients (56%) had a moderately active daily activity level. The study found that 16 patients had bilateral plantar fasciitiswhile nine had unilateral plantar fasciitis. Among the patients with bilateral plantar fasciitis, a total of 32 heels were affectedwhile the 9 patients with unilateral plantar fasciitis had 9 affected heels. Most female patients (75%) had bilateral plantar fasciitiswhile most male patients (56%) had unilateral plantar fasciitis. Before PRP therapy, both male and female patients reported high pain scores on theVASfor both heels. However, after PRP infiltration, the VAS scores significantly decreased at three weeks, three months, and six months post-injection, indicating pain relief. The AOFAS hindfoot and ankle scores and FAAM scores showed improvement over the follow-up period. Both male and female patients experienced significant improvements in functional outcomes, with increases in AOFAS (p-value 0.45) and FAAM scores (p-value 0.31) at three weeks, three months, and six months post-injection compared to baseline. Statistical analysis revealed a significant decrease in pain scores (73% pain relief), as well as significant improvements in AOFAS scores with an average of 22.33 from baseline (mean = 67.75±9.7) to final follow-up (mean = 90.08±7.9) and FAAM scores with an average of 23.72 from baseline (mean = 49.38±5.2) to final follow-up (mean = 73.10±5.2) after PRP infiltration. Conclusion The outcomes of a single dosage of PRP injections demonstrate clinically and statistically substantial improvements in functional outcome scores, plantar fascia thickness evaluated by USG, and VAS scores for heel pain. According to the results of this study, local PRP injection is an effective treatment for chronic plantar fasciitis.

Outcomes of Platelet-Rich Plasma Infiltration and Weightbearing Cast Immobilization in Distal Tibialis Anterior Tendinopathy: A Prospective Cohort Study.

Distal tibialis anterior tendinopathy (DTAT) is a chronic condition that may lead to functional impairment and secondary forefoot deformities when left untreated. Current clinical practice is mainly guided by case reports and small retrospective case series; little consensus exists on which treatment protocol is most effective. This study aims to assess a conservative treatment for DTAT consisting of PRP infiltration and walking cast immobilization. This prospective study included 18 feet in 18 patients, recruited between September 2020 and September 2022 at a single institution. Ultrasonography was performed; leukocyte-poor PRP was infiltrated around the tibialis anterior tendon insertion. Walking cast immobilization was used for 3 weeks after infiltration, followed by eccentric exercises of the DTAT, and gastrocnemius-soleus muscle complex stretching. Clinical findings, visual analog scale (VAS), Foot Function Index (FFI), and American Orthopaedic Foot & Ankle Society (AOFAS) midfoot scores were recorded at inclusion, and 6 and 12 weeks after PRP infiltration. Minimal clinically important difference (MCID) limits were researched to assess clinical relevance of statistical outcomes. Means were determined for age, sex, and body mass index (BMI). One-way repeated measures ANOVA was performed over time for FFI, AOFAS, and VAS scores. Mean age was 65 years with a mean BMI of 25. Tendon thickening and hypoechogenicity were the most commonly reported ultrasonographic findings. Significant improvement from baseline VAS (VASrest: 4.71 ± 2.7, VASactivity: 5.66 ± 2.5) to 12 weeks follow-up (VASrest: 2.14 ± 2.7, VASactivity: 3.34 ± 2.5) was found. Both AOFAS and FFITotal improved significantly from baseline (AOFAS: 66.9 ± 3.3, FFITotal: 32.9 ± 3.3) to 6-week follow-up (AOFAS6w: 79.4 ± 3.3, P = .019; FFITotal: 19.4 ± 3.3, P = .011). No statistically significant further improvement was found at 12 weeks compared to 6 weeks' follow-up. Two (11%) patients chose operative treatment because of persisting symptoms. We found that PRP infiltration with walking cast immobilization as a first-line treatment was associated with general early symptom improvement. Level IV, case series.

Randomised control trial of epidural platelet rich plasma versus epidural steroids for low back pain

Background: Lower back pain (LBP) is a prevalent medical condition that frequently results in work-related disability and is one of the leading causes of missed workdays. Low back pain (LBP) struck 619 million people worldwide in 2020, and by 2050, it's predicted that there will be 843 million instances worldwide. 70 to 85% of people are predicted to suffer from LBP at some point of time in their lives. 90% of these people will experience multiple episodes, and an intervertebral disc prolapse accounts for a significant portion. Medications and lifestyle adjustments may be used as the first line of treatment. However, if the symptoms do not improve, minimally invasive procedures such as epidural steroid injection and epidural platelet-rich plasma injection may relieve the pain and lessen disability. We therefore aim to conduct a study to analyse the patient’s functional status and satisfaction after epidural platelet-rich plasma infiltration. Methods: Eligible patients with low back pain will be divided into two groups(Group A and Group B). Patients in group A will receive epidural steroid whereas Group B will receive epidural Platelet rich plasma. These patients will be monitored where visual analogue scale will be used to assess relief of pain before and after the procedure, Straight leg raising test will be used to understand the improvement of the patient clinically during examination pre and post procedure. Oswestry disability index will be used to compare the outcome in patient's day to day activities before and after the intervention. Patients will be evaluated with these methods pre-procedure and 1 hour after and later follow up evaluation will be done after 3 weeks and 3 months. The follow-up scores will be taken post one hour, three weeks and three months of the treatment. Protocol version: v1 dated 04/07/23 CTRI registration: REF/2023/06/068736 (12/06/2023)

Platelet-rich plasma for jumper's knee: a comprehensive review of efficacy, protocols, and future directions.

This comprehensive review evaluates the current state of platelet-rich plasma (PRP) treatment for jumper's knee, also known as patellar tendinopathy. The aim is to assess the efficacy of PRP as a therapeutic option compared to other available procedures, investigate the benefits and potential drawbacks of PRP infiltration, and provide insights into the optimal protocols for PRP preparation and administration. A comprehensive literature search of English articles published up to June 2023 was conducted using PubMed and Scopus databases. Studies evaluating PRP for treating jumper's knee or patellar tendinopathy were analyzed to assess the current state of research in this field. PRP has demonstrated promising results in promoting cellular remodeling and accelerating the healing process in the jumper's knee. It shows potential benefits in pain reduction, improved function, and accelerated recovery. However, the efficacy of PRP varies depending on patient characteristics, disease severity, and the specific administration methodology. Establishing standardized PRP preparation and administration protocols are necessary to optimize its effectiveness. Further research is needed to define appropriate patient selection criteria and refine the application of PRP therapy in patellar tendinopathy management. Jumper's knee is commonly managed conservatively, but there is a lack of consensus on further treatment options. PRP treatment holds promise in promoting tissue healing and repair. However, standardized protocols for PRP preparation and administration, as well as optimal dosage and number of injections, require further investigation to enhance its efficacy. Continued research efforts are necessary to ascertain the precise role of PRP and its refinement in the management of patellar tendinopathy.

High survival rate after the combination of intrameniscal and intraarticular infiltrations of platelet-rich plasma as conservative treatment for meniscal lesions.

To evaluate the efficacy of applying a combination of intrameniscal and intraarticular infiltrations of Platelet-Rich Plasma (PRP) in patients with meniscal tears, analyzing its failure rate and clinical evolution, as well as factors that may influence the positive response to this treatment. Three hundred and ninety-two cases out of 696 met the inclusion criteria and were included in this work. Survival and patient-reported outcome measure (PROM) were collected and analyzed. Survival rate was defined as the percentage of patients who did not undergo meniscus surgery during their follow-up time. Patients were asked to complete the Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline, 6months and 18months. Other patient- and pathology-related variables were collected. Blood and PRP samples were randomly tested as a quality control measure. Survival and comparative statistical tests, and multivariate regression were performed for the analysis of the variables. The PRP applied had a platelet concentration factor of 1.9X in respect to blood levels, with no leukocytes or erythrocytes. Thirty-eight patients required surgical intervention after treatment reaching a survival rate of 90.3% with an estimated mean survival time of 54.4months. The type of injury (P = 0.002) and the presence of chondropathy were risk factors for surgical intervention after PRP treatment (P = 0.043). All KOOS scores showed a significant statistical increase from baseline to 6months (N = 93) and 18months (N = 66) (P < 0.0001). The number of cases with minimal clinically important improvement (MCII) at 6months and 18months post-treatment was 65 (69.9%) and 43 (65.2%), respectively. The combination of intrameniscal and intraarticular PRP infiltrations is a valid conservative treatment for meniscal injuries avoiding the need for surgical intervention. Its efficacy is higher in horizontal tears and decreases when joint degeneration is present. Level IV.

Regeneration of Partial Anterior Cruciate Ligament Tears Using the Technique of Biologic Augmentation with Bone Marrow Concentrate and Platelet-Rich Plasma Under Arthroscopic Visualization

To present clinical outcomes in a preliminary patient cohort using a biologic augmentation technique consisting of intra-ligamentous and intra-articular infiltration of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) under arthroscopic visualization for treatment of isolated and acute partial anterior cruciate ligament (ACL) tears. Athletes with an acute symptomatic partial ACL injury with clinical examination findings of increased anterior tibial translation without rotational instability were treated with the biologic augmentation technique. Patients were followed for 2 years postoperatively. The Lysholm Knee Questionnaire, IKDC Objective score, physical examination findings, MRI, and the KT-1000 arthrometer were used to assess clinical outcomes. Five patients were included in the analysis with a median age of 22. All patients were determined to have a healed ACL on MRI 8 months postoperatively. The median Lysholm Score at the final follow-up of 99 was significantly increased from the median pre-operative score (p = 0.042). In addition, the objective IKDC score improved in all patients postoperatively, and no clinical examination findings of knee instability were identified at the final follow-up. The median side-to-side difference in KT-1000 arthrometer testing was 3 mm pre-operatively and 0 mm at the last follow-up (p = 0.038). The treatment of appropriately indicated partial ACL injuries in this study has demonstrated that restoration of ligamentous structure and function may be achieved by a biologic augmentation technique using intra-ligamentous and intra-articular infiltration of BMAC and PRP. This technique is performed with minimal technical difficulty, leading to excellent 2-year clinical outcomes in this preliminary series of patients.

A comparative study between intraarticular infiltration of platelet rich plasma and hyaluronic acid in osteoarthritis knee

Background: Osteoarthritis (OA) is the most common progressive musculoskeletal condition that can affect joints, but it mainly affects the hips and knees as predominant weight-bearing joints and is characterized by structural modifications to primarily articular cartilage and subchondral bone, Hoffa’s fat pad, synovia, ligaments and muscles, leading to the concept of OA as a whole joint disease. Hence the present study was undertaken to evaluate the outcomes of platelet rich plasma (PRP) and hyaluronic acid (HA) intra-articular injections in patients with OA in terms of pain by numerical pain score and VAS and to evaluate the outcomes of PRP and HA intra-articular injections in patients with OA in terms of functional outcome by WOMAC scores. Methods: The study was a prospective hospital-based study in Kempegowda Institute of Medical Sciences between 2020 to 2022. The study was conducted on 100 patients, more than the age of 50 years of either gender with grade I-III OA of the knee fulfilling the inclusion and exclusion criteria. Patients were followed up at 6, 12 and 24 weeks for data collection and data was analyzed after follow-up visits were completed for all patients. Results: On intragroup analysis, there was significant reduction in the mean WOMAC score in both the study groups across time-points (p&lt;0.05). On intragroup analysis, there was significant reduction in the mean VAS score in both the study groups across time-points (p&lt;0.05). On intergroup analysis at any time point of follow-up, the mean WOMAC score was noted to be statistically comparable between the study groups (p&gt;0.05). Conclusions: In patients with symptomatic knee OA, intra-articular HA and PRP provide short term improvement in pain and function. Both the therapy agents for OA were associated with equivalent safety, with no complications.

Mid-term symptomatic relief after platelet-rich plasma infiltration in vulvar lichen sclerosus

PurposeVulvar lichen sclerosus (LS) is a chronic, progressive, autoimmune dermatologic condition that causes cutaneous changes accompanied by pruritus and pain. There remains a small population with vulvar LS refractory to topical corticosteroids. Injection of platelet-rich plasma (PRP) has been reported to have positive effects on tissue repair. The aim of this pilot study was to evaluate changes in symptom scores during and after PRP vulvar infiltration.MethodsThree PRP infiltrations were administered to 28 female postmenopausal patients with biopsy-proved LS with unsatisfactory response to steroid therapy. Change in score according to the Clinical Scoring System for Vulvar Lichen Sclerosus (CSS) was measured on six occasions over the course of a year. We used growth curve modeling to measure change over the period of the study.ResultsWomen in our study experienced a statistically significant improvement in auto-assessed symptoms of vulvar lichen sclerosus, and this improvement appears to be maintained throughout the monitoring year.ConclusionPlatelet-rich plasma may have a role in symptom relief in certain cases of patients with LS that do not respond to first-line therapy.

Comparative efficacy of ultrasonically guided infiltration of single shot of platelet-rich plasma and triamcinolone acetonide in adhesive capsulitis of shoulder joint - a prospective clinical study

Background: Adhesive capsulitis is also termed periarthritis of the shoulder joint or frozen shoulder. It is the most common cause of pain in and around the shoulder joint, extending up to the insertion of the deltoid muscle in the middle of the arm. The incidence of adhesive capsulitis ranges from 2% to 5%. It is prevalent in the middle-aged (40–60 years) group. Females suffer more from this condition. In the recent past, the infiltration of steroids into the shoulder joint was the mainstay of the treatment. Platelet-rich plasma (PRP) has appeared as a new hope for such patients, as it is believed to enhance the revascularization of the soft tissue and also increase the concentration of growth factors to improve and accelerate tendon healing. Aims and Objectives: This present study was done to evaluate the relative efficacy of ultrasonically guided infiltration of PRP and triamcinolone acetonide. Materials and Methods: The present clinical prospective study was conducted on 50 patients in a tertiary institute in Punjab, India, from June 2018 to December 2020 to evaluate the comparative efficacy of ultrasonically guided infiltration through the posterior approach of PRP and triamcinolone acetonide in the outdoor patient department of the department of orthopedics. The patients selected for the intra-articular infiltration were in their middle age (40–60 years), diagnosed as having adhesive capsulitis with non-resolution of signs and symptoms for the last 12 weeks. Results: PRP was a superior alternative to triamcinolone acetonide in the management of adhesive capsulitis as it resulted in long-term improvement in the visual analog score and disability of arm, shoulder, and hand scores with significant margins. Conclusion: PRP is definitively a newer, effective, cost-effective, autogenously derived alternative to the corticosteroids used till date, as it not only provides a long lasting effect but also helps in regenerative medicine.

Effects of Platelet-rich Plasma Infiltration to Donor Area on Harvested Fat Grafts

Effects of Platelet-rich Plasma Infiltration to Donor Area on Harvested Fat Grafts

Locally Injected Autologous Platelet-Rich Plasma Improves Cutaneous Wound Healing in Cats.

Simple SummaryWound healing in cats is a complex process that can be accomplished by first or second intention. Autologous platelet-rich plasma (PRP) is a product from patients’ own blood that has been found to promote wound healing in both humans and animals. The aim of this study was to investigate the efficacy of PRP infiltration in open wounds in cats. It was found that experimentally created wounds infiltrated with PRP showed a more rapid total wound healing and a better perfusion, supporting the use of PRP in open wounds in laboratory cats. In conclusion, PRP is considered a cost-effective and simple method to accelerate open-wound healing in cats.Cutaneous defects in cats are commonly encountered in clinical practice, and healing can be accomplished by first or second intention. Platelet-rich plasma (PRP) is characterized by a plasma concentration containing a large number of platelets in a small volume of plasma. The objective of the present study was to record the efficacy of PRP infiltration in open wounds in laboratory cats. Six wounds were created in the dorsal midline of eight laboratory cats, with the wounds of one side designated as the PRP group and the wounds of the other side as the control group. Wound healing was evaluated by daily clinical examination, planimetry, laser Doppler flowmetry, and histologic examination on days 0, 7, 14, and 25, and by measurement of metalloproteinases (MMPs)-2 and -9 and tissue inhibitor metalloproteinase (TIMP)-1 on days 0, 14, and 25. Based on the results of the present study, the mean time for full coverage with granulation tissue was shorter in the PRP group, the mean contraction and total wound healing percentage were increased compared to the control group, and finally, the perfusion measured with laser Doppler flowmetry was higher in the PRP group during all examination days. In conclusion, this is the first study focusing on the topical application of PRP in the treatment of open wounds in laboratory cats, and our results are encouraging—showing a more rapid healing in the PRP group.

Effect of Combined Intraosseous and Intraarticular Infiltrations of Autologous Platelet-Rich Plasma on Subchondral Bone Marrow Mesenchymal Stromal Cells from Patients with Hip Osteoarthritis.

Osteoarthritis (OA) is a debilitating condition that significantly impacts its patients and is closely associated with advancing age and senescence. Treatment with autologous platelet rich plasma (PRP) is a novel approach that is increasingly being researched for its effects. Subchondral bone mesenchymal stromal cells (MSCs) are key progenitors that form bone and cartilage lineages that are affected in OA. This study investigated the changes in subchondral bone MSCs before and after combined intraosseous (IO) and intraarticular (IA) PRP infiltration. Patient bone marrow aspirates were collected from 12 patients (four male, eight female) aged 40–86 years old (median 59.5). MSCs were expanded in standard media containing human serum to passage 1 and analysed for their colony-forming potential, senescence status, and gene expression. Hip dysfunction and Osteoarthritis Outcome Score (HOOS) at baseline and 6 months post second infiltration were used to assess the clinical outcomes; seven patients were considered responders and five non-responders. The number of colony-forming MSCs did not increase in the post treatment group, however, they demonstrated significantly higher colony areas (14.5% higher compared to Pre) indicative of enhanced proliferative capacity, especially in older donors (28.2% higher). Senescence assays also suggest that older patients and responders had a higher resistance to senescent cell accumulation. Responder and non-responder MSCs tended to differ in the expression of genes associated with bone formation and cartilage turnover including osteoblast markers, matrix metalloproteinases, and their inhibitors. Taken together, our data show that in hip OA patients, combined IO and IA PRP infiltrations enhanced subchondral MSC proliferative and stress-resistance capacities, particularly in older patients. Future investigation of the potential anti-ageing effect of PRP infiltrations and the use of next-generation sequencing would contribute towards better understanding of the molecular mechanisms associated with OA in MSCs.

ROLE OF PLATELET RICH PLASMA IN TREATMENT OF BED/PRESSURE SORES IN PATIENTS WITH ORTHOPEDIC INJURIES

Aim: To assess the effect of Platelet rich plasma (PRP) on healing of bed/pressure sores among immobilized orthopaedic patients. A total of 138 patients with orthopaedic injuries under immobilization for &gt;15 days to 5Method: years with presence of bed sores were enrolled in the study. Nature of wound (acute/chronic), duration of immbolization, wound and wound size was noted. Blood samples were obtained from all the patients and autologous PRP was prepared. Each patient received 5 ml of autologous PRP directly at the wound site. The process was repeated at every 4th day till achievement of &gt;50% reduction or till day 60th. Final outcome was noted in terms of failure (&lt;50% reduction), partial resolution (&gt;50% reduction) and complete resolution (complete wound healing). Data was analysed using Independent samples 't'-test. Mean age of patients was 39.89±17.07 years and majority were males (75.4%) There were a totalResults: of 169 wounds. There was a dominance of acute wounds (79.9%). Mean wound size was 62.17±115.92 cm2. Mean duration of immobility was 98.41±40.31 days. Mean number of PRP infiltrations was 4.30±2.18. At final follow up 127 (75.1%) had complete resolution and remaining 42 (24.9%) had &lt;50% reduction in wound size. No significant difference in wound size was observed between chronic and acute wounds at different follow-up intervals. PRP proved to beConclusion: effective in healing of bed sores of both chronic as well as acute origin in immobilized orthopaedic patients.

Clinical Response After Treatment of Knee Osteoarthritis With a Standardized, Closed-System, Low-Cost Platelet-Rich Plasma Product: 1-Year Outcomes.

Background:Intra-articular infiltration of platelet-rich plasma (PRP) is an alternative therapeutic option to classic hyaluronic acid for the treatment of symptomatic knee osteoarthritis (KOA). However, variation in preparation methods and quality assessment of PRP makes the study of its real clinical efficacy difficult.Purpose:To (1) evaluate the clinical efficacy of a characterized PRP product prepared in a standardized manner and in a closed-system for the treatment of KOA and to (2) evaluate the association of the clinical response to PRP-related variables.Study Design:Case series; Level of evidence, 4.Methods:We recruited 130 patients with nonoperative KOA and evaluated them for 1 year. PRP was prepared from a donation of autologous blood, obtaining 3 aliquots of approximately 10mL of product, which were frozen, allowing platelet disruption, platelet factor release, and long-term storage, until administration. Patients were treated 3 consecutive times every 4 weeks with an intra-articular PRP knee injection under sterile conditions. Complete blood count was performed on the whole-blood sample and the processed PRP before freezing it, for product quality assessment. Patients were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and basic satisfaction scale at 3 months, 6 months, and 1 year after intervention.Results:Quality assessment confirmed a leukocyte-poor PRP product (white blood cell count, 0.09 ± 0.09 × 109/L) with a high platelet purity (platelet count, 630.86 ± 191.75 × 109/L). WOMAC scores improved, and basic satisfaction was achieved in 70% of patients. No adverse events were reported. No correlations were observed between PRP quality parameters and clinical results. PRP complete treatment production costs were €108/US$125 (€36/US$41.6 per injection).Conclusion:This standardized PRP production method resulted in improved WOMAC scores at 1 year postoperatively in 70% of patients with KOA. This technique was safe and affordable and ensured consecutive infiltrations with the same product to each patient.

Effectiveness of platelet-rich plasma in the treatment of conditions foot orthotics

Introduction: In orthopedics, the use of rich plasma is still controversial, there is no consensus regarding its indications, and use, although its therapeutic usefulness for various conditions is proven, much remains to be studied on this promising topic. Purpose: With our study we intend to assess the clinical effectiveness and efficacy of the treatment imposed according to study groups. Method. A prospective pre-experimental study was carried out in adults with a diagnosis of orthopedic foot injuries, treated at the Orthopedics and Traumatology Service of the General University Hospital "Mártires del 9 de Abril", from January 2018 to December 2022, where the utility of the PRP is used and valued. Results Orthopedic foot injuries are more common in women between 41 and 60 years of age, 15.9% of the sample was treated with infiltration of platelet-rich plasma, pain decreased in all study groups, without However, the group where PRP infiltration is used represents the one with the best evolution of the patients seen in the clinic. Conclusions The results obtained in this study show that the treatment protocol applied is positive in each of the therapeutic options used from the point of view of pain improvement according to the visual analogue scale, highlighting the option of using PRP.

Prediction of clinical response to corticosteroid or platelet-rich plasma injection in plantar fasciitis with MRI: A prospective, randomized, double-blinded study

PurposeThe purpose of this study was to identify association between magnetic resonance imaging (MRI) features and clinical data at baseline and six months following platelet-rich plasma (PRP) or corticosteroid (CS; cortivazol) injection in patients with plantar fasciitis, and to identify initial MRI criteria associated with a favorable clinical response to treatment. Material and methodsThe study was registered on ClinicalTrials.gov (NCT03857334). MRI examinations of 36 patients with plantar fasciitis lasting more than 3 months who were randomly assigned to receive ultrasound-guided PRP (PRP group, 20 patients) or CS (CS group, 18 patients) injection were quantitatively and qualitatively analyzed with respect to plantar fascia thickness, plantar fascia hyperintensity on T2-weighted STIR (HSTIR) images, calcaneal bone marrow and surrounding soft tissues. Clinical evaluation including visual analytic scale (VAS) assessment and MRI examinations were obtained before and 6 months after treatment. Good clinical response was defined as pain VAS decrease > 50% at 6 months. ROC curves with AUC measurements were used to determine cut-off points. ResultsIn the whole study population, an association was found between MRI features (deep soft tissue and calcaneal bone marrow HSTIR) and pain VAS scores for the first steps of the day (P = 0.028 and P = 0.007, respectively). No significant radioclinical associations on post-treatment MRI examinations were found in either group. Initial coronal thickness of plantar fascia was associated with a good clinical response in the CS group (P < 0.01). ROC curve analysis found that 7-mm or thicker plantar aponeurosis at initial MRI was predictive of good clinical response in patients with CS treatment (Youden index = 0.6). PRP infiltrations were effective regardless of fascia thickness (73% of patients with ≤ 7 mm aponeurosis and 67% for thicker ones). ConclusionInitial facia thickness (> 7 mm) is predictive of good clinical response six months after CS injection, whereas PRP injection shows effectiveness regardless of fascia thickness.

A Novel Treatment of Painful Medial Collateral Ligament Calcification (Pellegrini–Stieda Syndrome): A Case Report

A 63-year-old healthy woman was diagnosed clinically and radiographically with Pellegrini-Stieda syndrome. She had failed to improve with 6 months of conservative management using oral anti-inflammatories and physiotherapy. Local corticosteroid injections were offered on 2 occasions, 4 months apart, and provided excellent but only temporary relief of symptoms. The patient agreed to undergo ultrasound-guided percutaneous lavage, followed by platelet-rich plasma infiltration of the Pellegrini-Stieda lesion instead of being referred for surgery. The patient was assessed clinically and radiographically at 12 weeks and 18 months postprocedure. At both appointments, the patient reported a significant reduction in pain and improvement in function as rated by the Lower Extremity Function Scale (improvement of 20 points at 12 weeks and an improvement of 16 points at 18 months postprocedure). Radiographically, the Pellegrini-Stieda lesion was no longer visible at either follow-up interval. In conclusion, ultrasound-guided percutaneous calcific lavage followed by autologous platelet-rich plasma infiltration may be an effective way to treat refractory cases of Pellegrini-Stieda syndrome.