Leucocyte-rich Platelet-rich Plasma Research Articles

Prospective Comparative Short-Term Study of Autologous Leucocyte-Rich Platelet-Rich Plasma vs. Local Steroids in Chronic Plantar Fascitis

Background Plantar fasciitis is the most common cause of heel pain and is difficult to treat in most chronic and severe forms. Management of plantar fasciitis includes non-surgical options such as non-steroidal anti-inflammatory drugs and corticosteroids, physical therapy, orthotics, and surgical management includes plantar fasciotomy. Local injection of platelet-rich plasma as well as local steroids is an emerging concept in treating recalcitrant tendon and ligament pathology, including plantar fasciitis. Objectives The aim of the study was to evaluate and compare the outcome of patients treated with a single injection of autologous leucocyte-rich platelet-rich plasma with single-injection local steroids triamcinolone in chronic plantar fasciitis. Methodology The study was conducted for a duration of 24 months. In total, 60 patients with clinically diagnosed chronic plantar fasciitis were selected for study and divided in two groups using the single allocation randomization method as those treated with autologous injection leucocyte-rich platelet-rich plasma and those with injection local steroid triamcinolone and prospectively followed and compared. Results Both groups were evaluated subjectively and functionally at primary visit and then on follow-up at 2 weeks, 4 weeks, 8 weeks, and 12 weeks by VAS and hind foot AOFAS score. Conclusion We concluded that both injection platelet-rich plasma-treated and injection local steroid-treated patients provide symptomatic relief in the treatment of chronic plantar fasciitis both subjectively and functionally. The steroid treated group showed early symptomatic improvement at 2 weeks, and results at 12 weeks to further follow-up were suggestive that single-injection leucocyte-rich platelet-rich plasma provided better functional results.

A Regenerative Interventional Approach to the Management of Degenerative Low Back Pain

Objective: Low back pain has been strongly related to the degenerative process of the spine, especially the degeneration of the intervertebral disc and facet joints. The main procedures for the management of low back pain are no intended to slow down or reverse the degenerative process. Platelet Rich Plasma (PRP), an orthobiologic product, has been the subject of several studies in the management of low back pain. Methods: A prospective case series study presenting the clinical results of 23 patients treated with PRP injections performed following clinical a interventionist protocol called PerMuTIS – Personalized Multi Target Biologic Injection of the Spine. The method to obtain the platelet concentrate was the Simple Double Spin technique, a low-cost double spin that produces Leucocyte Rich PRP. Baseline scores of pain and disability using the Visual Analog Scale (VAS) and Roland-Morris Disability Questionnaire (RMDQ) were recorded. Results: Mean VAS pain score across the cohort decreased by approximately 62%, while the Roland-Morris disability score decreased by about 60% at 52 weeks. There was no report of adverse events. The Leucocite and Monocite Rich PRP product showed concentration of 4.3X above baseline, with monocites concentration of 3.2X baseline. Conclusion: The concept of application in multiple targets using a simple and low-cost preparation technique proved to be feasible and without reports of serious side effects that compromise its indication. The PerMuTIS – Personalized Multi Target Biologic Injection in the Spine Technique using Simple Double Spin protocol demonstrated safety and feasibility in this prospective study of patients with low back pain who failed conservative treatments. Large scale, multicenter randomized clinical trial will provide an appropriate level of evidence to assist in clinical practice.

Can platelet-rich plasma injections provide better pain relief and functional outcomes in persons with common shoulder diseases: a meta-analysis of randomized controlled trials.

BackgroundTo evaluate the efficacy of autologous platelet-rich plasma (PRP) injections in the treatment of common shoulder diseases.MethodsThe PubMed, Medline, and Central databases and trial registries were searched from their inception to October 2020 for randomized controlled trials of autologous PRP injections for shoulder diseases versus placebo or any control intervention. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines were followed in the selection, analysis, and reporting of findings. The primary outcome was pain intensity (visual analog scale), and secondary outcomes were changes in function and quality of life (QoL).ResultsA total of 17 randomized controlled trials of PRP versus control were analyzed. From 8–12 weeks to ≥1 year, PRP injections were associated with better pain relief and functional outcomes than control interventions. PRP injections were also associated with greater QoL, with an effect size of 2.61 (95% confidence interval, 2.01–14.17) at medium-term follow-up. Compared with placebo and corticosteroid injections, PRP injections provided better pain relief and functional improvement. In subgroup analyses, trials in which PRP was prepared by the double centrifugation technique, the platelet concentration in the PRP was enriched ≥5 times, leucocyte-rich PRP was used, or an activating agent was used before application reported the most effective pain relief at 6–7 months.ConclusionsPRP injections could provide better pain relief and functional outcomes than other treatments for persons presenting with common shoulder diseases. PRP injections have a greater capacity to improve shoulder-related QoL than other interventions.

Does leucocyte concentration have a role in the outcome of PRP therapy for lateral epicondylitis – A randomized controlled trial

Does leucocyte concentration have a role in the outcome of PRP therapy for lateral epicondylitis – A randomized controlled trial - IJOR- Print ISSN No: - 2581-8112 Online ISSN No:- 2581-9151 Article DOI No:- 10.18231/j.ijor.2020.020, IP International Journal of Orthopaedic Rheumatology-IP Int J Orthop Rheumatol

Leucocyte-Rich Platelet-Rich Plasma Enhances Fibroblast and Extracellular Matrix Activity: Implications in Wound Healing.

Background: Platelet-rich plasma (PRP) is an autologous blood product that contains a high concentration of platelets and leucocytes, which are fundamental fibroblast proliferation agents. Literature has emerged that offers contradictory findings about leucocytes within PRP. Herein, we elucidated the effects of highly concentrated leucocytes and platelets on human fibroblasts. Methods: Leucocyte-rich, PRP (LR-PRP) and leucocyte-poor, platelet-poor plasma (LP-PPP) were compared to identify their effects on human fibroblasts, including cell proliferation, wound healing and extracellular matrix and adhesion molecule gene expressions. Results: The LR-PRP exhibited 1422.00 ± 317.21 × 103 platelets/µL and 16.36 ± 2.08 × 103 white blood cells/µL whilst the LP-PPP demonstrated lower concentrations of 55.33 ± 10.13 × 103 platelets/µL and 0.8 ± 0.02 × 103 white blood cells/µL. LR-PRP enhanced fibroblast cell proliferation and cell migration, and demonstrated either upregulation or down-regulation gene expression profile of the extracellular matrix and adhesion molecules. Conclusion: LR-PRP has a continuous stimulatory anabolic and ergogenic effect on human fibroblast cells.

Study protocol for a double-blind, randomised placebo-controlled trial evaluating clinical effects of platelet-rich plasma injection for acute grade-2 hamstring tear among high performance athletes

IntroductionHamstring injury among athletes often results in significant morbidity. Currently, there are controversies regarding the clinical use of platelet-rich plasma (PRP) for the treatment of acute hamstring injury.Methods and analysisThis...

Characteristics of autologous protein solution and leucocyte-poor platelet-rich plasma for the treatment of osteoarthritis of the knee

Recently, platelet-rich plasma (PRP) has received attention as a treatment for patients with osteoarthritis of the knee (OAK), a chronic degenerative disease, to bridge the gap between conservative and surgical treatments. Here, we investigated the differences in the humoral factors present in two types of PRP purified using the Autologous Protein Solution (APS) kit (group Z; leucocyte-rich PRP) or the Cellaid Serum Collection Set P type (group J; leucocyte-poor [LP]-PRP). Differences in humoral factors between healthy subjects (n = 10) and OAK patients (n = 12; group Z = 6, group J = 6), and the relationship between humoral factors and clinical outcome scores were investigated. Both anti-inflammatory and inflammatory cytokines were highly enriched in APS. The concentrations of tumour necrosis factor (TNF)-α, platelet-derived growth factor, fibroblast growth factor, soluble TNF-receptor 2, soluble Fas and transforming growth factor-β1 were higher in group Z, while the total amounts were higher in group J. The concentration of interleukin-1 receptor antagonist was positively correlated with the magnitude of change in the clinical outcome score and may contribute to improving knee-joint function. This is the first description of the humoral factors in APS and LP-PRP prepared from healthy subjects or OAK patients of Asian descent.

A Randomized Double-Blind Controlled Pilot Study Comparing Leucocyte-Rich Platelet-Rich Plasma and Corticosteroid in Caudal Epidural Injection for Complex Chronic Degenerative Spinal Pain.

To compare the efficacy and safety between leucocyte-rich platelet-rich plasma (LR-PRP) and corticosteroid in fluoroscopically guided caudal epidural injection for patients with complex chronic lumbar spinal pain. A prospective randomized controlled double-blinded study. Fifty eligible patients with complex chronic degenerative spinal pain were randomly assigned with a 1:1 allocation ratio to receive caudal epidural injection of corticosteroid (triamcinolone acetonide, 60mg) or LR-PRP (isolated from 60mL autologous blood) under fluoroscopic guidance. Levels of low back pain, quality of life, and complications (or adverse effects) were evaluated at 1, 3, and 6months after treatment. Pain levels and quality of life were assessed using the VAS and Short Form 36-Item Health Survey (SF-36), respectively. No significant difference was shown at baseline between the 2 groups. Compared with the pretreatment values, there were significant reductions in the VAS score in both groups. A significantly lower VAS score at 1-month follow-up was detected in patients who received corticosteroid injection. However, the scores were lower in the LR-PRP group at 3- and 6-month follow-up. SF-36 responses at 6 months showed significant improvement in all domains in the LR-PRP group. There were no complications or adverse effects related to treatment at 6-month follow-up in either group. Both autologous LR-PRP and corticosteroid for caudal epidural injections under fluoroscopic guidance are equally safe and therapeutically effective in patients with complex chronic lumbar spinal pain. However, LR-PRP is superior to corticosteroid for a longer pain-relieving effect and improvement in quality of life.

Hope, Hype, Hurdles & Future Perspective for PRP, PRP versus Hyaluronic Acid Injection in Osteoarthritis of Knee: A Review Article.

BackgroundComparative studies of platelet-rich plasma (PRP) and hyaluronic acid show variable results.
 PurposeA review was conducted to understand the current role of PRP and its efficacy versus hyaluronic acid in osteoarthritis (OA) of the knee joint.
 MethodsOut of 170 identified studies, 14 studies involving 1575 patients with 637 males and 938 females were selected based on PRISMA flow chart guidelines and were analyzed for the study.
 ResultsA standard PRP regimen consisting of 2–3 intra-articular injections (IA) of 4–6 mL of leucocyte poor PRP at 1–2 weekly intervals provides a better result than HA during the first 3–6 months, and which may continue up to one year. PRP and HA may have synergistic effect; pain and swelling are the two most com-mon complications with PRP, the incidence is more with leucocyte rich PRP (LP-PRP) and intra-osseous PRP treatment.ConclusionPRP provides hope and is more effective than hyaluronic acid in pain relief and improving the quality of life in mild to moderate osteoarthritis of the knee joint. However, hype, that is effective in all, irrespective of grades of OA, mal-aligned or stiff knee, ligamentous laxity, and can avoid joint replacement is a big hindrance in establishing it as a preferred treatment in OA knee. The author follows the above-mentioned PRP regimen; and recommends to combine leucocyte poor PRP with HA for IA injections & with LP-PRP injections along with the two most common painful points (medial collateral ligament, pesanisernius) in a highly painful OA knee. PRP may not address extra-articular causes of knee pain (mal-alignment, muscle wasting, tendinosis), should be corrected for optimum outcome. Contact sports, running, exercises putting pressure on knee and NSAID should be avoided during PRP treatment. Also, more randomized controlled trials are required to further standardize the PRP preparation, administration, injection interval & proper documentation of efficacy and complications in the regenerative registry.

Leucocyte-Rich Platelet-Rich Plasma Treatment of Gluteus Medius and Minimus Tendinopathy: A Double-Blind Randomized Controlled Trial With 2-Year Follow-up

Background: A previously published trial showed that patients with chronic gluteal tendinopathy achieved greater clinical improvement at 12 weeks when treated with a single platelet-rich plasma (PRP) injection than those treated with a single corticosteroid injection (CSI). Purpose: This follow-up study was conducted to determine whether there would be a sustained long-term difference in the modified Harris Hip Score (mHHS) at 2 years for a leucocyte-rich PRP (LR-PRP) injection in the treatment of chronic gluteal tendinopathy. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: This trial included 80 patients randomized 1:1 to receive LR-PRP or CSI intratendinously under ultrasound guidance. Patients had a mean age of 60 years, a 9:1 ratio of women to men, a mean body mass index of 27, and a mean length of symptoms >15 months. No patients had full-thickness tears of the gluteal tendons. An open-labeled extension allowed patients to receive crossover treatment after 3 months. The main outcome measure was the mHHS. Results: The mean mHHS improved significantly at 12 weeks in the PRP group (74.05; SD, 13.92) as compared with the CSI group (67.13; SD, 16.04) (P = .048). At 24 weeks, the LR-PRP group (77.60; SD, 11.88) improved further than the CSI group (65.72; SD, 15.28; P = .0003). Twenty-seven patients were deemed to have failed the CSI treatment at 16 to 24 weeks, with an exit score of 59.22 (SD, 11.54), and then had treatment with LR-PRP. The crossover group improved with the LR-PRP: from 59.22 (SD, 11.22) at baseline to 75.55 (SD, 16.05) at 12 weeks, 77.69 (SD, 15.30) at 24 weeks, and 77.53 (SD, 14.54) at 104 weeks. The LR-PRP group retained 38 of 39 patients to 52 weeks and continued to improve. Their baseline scores of 53.77 (SD, 12.08) improved to 82.59 (SD, 9.71) at 104 weeks (P < .0001). Conclusion: Among patients with chronic gluteal tendinopathy and a length of symptoms >15 months, a single intratendinous LR-PRP injection performed under ultrasound guidance results in greater improvement in pain and function than a single CSI. The improvement after LR-PRP injection is sustained at 2 years, whereas the improvement from a CSI is maximal at 6 weeks and not maintained beyond 24 weeks. Registration: ACTRN12613000677707 (Australian New Zealand Clinical Trials identifier).

Comparing leukocyte-rich platelet-rich plasma injection with surgical intervention for the management of refractory tennis elbow. A prospective randomised trial.

Patients with ongoing symptoms after non-operative treatment of lateral epicondylosis are usually treated with surgical release. Platelet-rich plasma injection is an alternative treatment option. This study aims to determine whether there is a difference in outcome from platelet-rich plasma injection or surgical release for refractory tennis elbow. Eighty-one patients with a diagnosis of tennis elbow for a minimum of six months, treated with previous steroid injection and a minimum visual analogue scale pain score of 50/100 were randomised to open surgery release (41 patients) or leucocyte rich platelet-rich plasma (L-PRP) (40 patients). Patients completed the Patient-Rated Tennis Elbow Evaluation and Disability of the Arm Shoulder and Hand at baseline, 1.5, 3, 6 and 12 months post-intervention. The primary endpoint was change in Patient-Rated Tennis Elbow Evaluation pain score at 12 months. Fifty-two patients completed final follow-up. Functional and pain scores improved in both groups. No differences in functional improvements were found but greater improvements in Patient-Rated Tennis Elbow Evaluation pain scores were seen after surgery. Thirteen patients crossed over from platelet-rich plasma to surgery within 12 months, and one surgical patient underwent a platelet-rich plasma injection. L-PRP and surgery produce equivalent functional outcome but surgery may result in lower pain scores at 12 months. Seventy per cent of patients treated with platelet-rich plasma avoided surgical intervention.

Magnetic resonance and ultrasound in achilles tendinopathy: Predictive role and response assessment to platelet-rich plasma and adipose-derived stromal vascular fraction injection

ObjectiveTo assess the correlation between magnetic resonance and ultrasound findings and clinical outcome after intratendinous injection of leucocyte-rich platelet-rich plasma or adipose-derived stromal vascular fraction in patients with non-insertional Achilles tendinopathy. Materials and methodsForty-three patients (age: 47.8±5.1, range 29–55) with unilateral or bilateral non-insertional Achilles tendinopathy (58 tendons overall) were randomly assigned to platelet-rich plasma (22 patients, 28 tendons) or adipose-derived stromal vascular fraction (21 patients, 30 tendons) injection group. All patients underwent magnetic resonance (tendon cross-sectional area, signal intensity, maximum anteroposterior thickness were measured), ultrasound (maximum anteroposterior thickness, power Doppler signal, ultrasound gray scale echotexture were measured), and visual analogue scale (VAS) pain evaluation at baseline and at six months from treatment. Wilcoxon, intraclass correlation coefficient, repeated measure ANOVA tests were used. ResultsThere was a significant (P<0.001) decrease of mean VAS from pre-treatment (6.4±1.4) to six-month evaluation (1.8±1.7). Significant increase of tendon thickness measured using magnetic resonance (P=0.013) and ultrasound (P=0.012) and power Doppler signal (P=0.027) was seen. There was no significant difference between pre- and post-treatment cross sectional area, signal intensity, and echotexture (P>0.217). None of the pre-treatment parameters was a predictor of treatment outcome (P>0.104). There was an excellent agreement between tendon thickness measurement between magnetic resonance and ultrasound (intraclass correlation coefficient=0.986) ConclusionsBoth treatments seem to allow for clinical benefit, associated to early slight increase of tendon size and power Doppler signal. Imaging cannot be used as a predictor of clinical outcome.