Local Injection Of Platelet-rich Plasma Research Articles

Platelet-rich plasma has better mid-term clinical results than traditional steroid injection for plantar fasciitis: A systematic review and meta-analysis

IntroductionRecently, local platelet-rich plasma (PRP) injection has been gradually used in the treatment of plantar fasciitis (PF). However, compared with traditional steroid injection, the clinical results of local PRP injection for PF patients remain controversial. Therefore, we performed a systematic review to focus on two questions as follows: (1) is PRP more effective than steroid to relieve pain in PF patients? (2) is PRP more effective than steroid to improve the foot and ankle function of PF patients? HypothesisThe PRP could be more effective to relieve pain and improve the foot and ankle function in PF patients. Material and methodsWe systematically searched electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Web of Science, and Embase) from inception to October 20, 2019. The data of clinical results, including visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores, were extracted and analyzed. ResultsFinally, twelve randomized controlled trials (RCT), involving 653 PF patients, were enrolled. All enrolled trials were considered to be of high quality. The results showed that the VAS of the PRP group was significantly lower than that of the steroid group at 6-month (p=0.02), 1-year (p=0.02), and 1.5-year (p<0.00001) follow-up. The AOFAS scores of the PRP group were significantly higher than that of the steroid group at 1-year (p=0.005) follow-up. DiscussionCompared to local steroid injection, local autologous PRP injection is more effective in relieving pain and improving the foot and ankle function at mid-term follow-up. Level of evidenceII; Systematic review and Meta-analysis.

Effect of Platelet-Rich Plasma on Bone Healing in Immediate Implants Analyzed by Cone Beam Computerized Tomography: A Randomized Controlled Trial.

The possibility of platelet-rich plasma (PRP) on the improvement of bone and adjacent tissue recovery has previously been validated. However, there is insufficient data supporting the use of platelet-rich plasma to improve the healing of bone and adjacent tissues around an implant in the oral cavity. The purpose of this randomized controlled trial was to observe the effect of platelet-rich plasma (PRP) concentrate on marginal bone loss and bone density around immediate implant placement using Cone Beam Computerized Tomography (CBCT). This clinical study was conducted over a period of six months on 12 subjects, who were equally categorized into two groups. Group I was the control, whereas the subjects in Group II received PRP therapy at the surgical site. All subjects were given a standard treatment with a single implant system (DIO UFII hybrid sandblasted acid-etched implants). Inserted implants were analyzed through CBCT, and records were registered at baseline, at the 12th week before functional loading and the 26th week after functional loading. The bone loss was calculated at the proximal (mesial and distal) side of the implant and bone density at baseline, 12th week, and 26th week after implant placement. SPSS version 23.0 was used for statistical analysis of data. The changes in bone levels were measured and compared between the two groups using the Mann–Whitney U test, with no significant difference. Bone density was analyzed by an independent sample t-test, p value ≤ 0.05 was considered statistically significant. Again, no significant difference in bone density was observed between both groups at all three instances. Therefore, it can be concluded that local injection of PRP after immediate implant placement did not show any decrease in marginal bone loss or improvement in bone density. This trial is registered with NCT04650763.

Impact of Different PRP Centrifugation Speeds on Immunohistochemical Expression of RANK, RANKL and Alkaline Phosphatase in Experimentally Induced Periodontitis

Objectives: This study was conducted to evaluate the effect of two single centrifugation speeds used in platelet rich plasma (PRP) preparation on the expression of osteoclastogenic markers RANK, RANKL and the osteogenic marker Alkaline phosphatase (ALP) in experimentally induced periodontitis in a rat model. Material and Methods: Thirty four adult male Wistar rats, weighing 150-200 g were selected. Four rats for PRP preparation. Ligatures were placed subgingivally around the lower incisors of thirty rats in figure 8 manner. Ligature control was performed daily then after 14 days ligature removal was done and the rats were subsequently divided into 3 equal groups (n=10); group I: control non treated, group II: injected with 0.2ml PRP prepared with 800 rpm, group III: injected with 0.2ml PRP prepared by 3000 rpm. Five rats of each group were sacrificed after 3 and 6 weeks, the specimens were processed, then evaluated using haematoxylin and eosin, RANK, RANKL and ALP. The results were subjected to digital morphometric assessment followed by statistical analysis. Results: Both PRP treated groups showed better alveolar bone regeneration compared to control non treated group especially at the 6th week. Group II had better regenerative capacity compared to group I and III as it showed significant increase in the amount of ALP and significant decrease in the RANK and RANKL osteoclastogenic markers. Conclusion: Local injection of PRP with both tested centrifugation speeds enhanced the regenerative capacity of bone in experimentally induced periodontitis. However, the lower centrifugation speed (800 rpm) have better regenerative effect.

Local Platelet-rich plasma (PRP) injection for the treatment of Delayed Union after Internal Fixation in Fractures of Long Bones

Introduction: Long bone fractures are among the most common orthopaedic injuries encountered. A fracture that fails to progress to union despite appropriate fixation and absence of complications presents a treatment dilemma to the surgeon. The usual solution of re-fixation with or without bone graft constitutes repeat exposure to surgery and its risks, as well as added morbidity and cost. Recent advances in molecular biology suggest Platelet rich plasma (PRP) may have bone forming potential. This study was done to determine whether PRP has any beneficial role in patients with delayed healing of long bone fractures.&#x0D; Methods: A prospective interventional study was done on patients arriving at the department of orthopaedic surgery of Kathmandu Medical College with delayed union of long bone fractures after internal fixation between January 2014 and January 2017. Patients were treated with local injection of group-matched PRP directly into the fracture gap and were followed-up for six months to check for radiological signs of fracture union.&#x0D; Results: A total of 10 fractures were included in 10 patients that involved four humeri, three tibiae, and three femora. Eight out of the 10 fractures united at a median time of three months after the injection. Two had non-union that required revision surgery.&#x0D; Conclusion: Local Platelet rich plasma injection may constitute a ‘nothing to lose, everything to gain’ intermediate option before a decision for major reoperation on such patients is made.

Comparison of the effectiveness of subacromial administration of platelet-rich plasma and hyaluronic acid in chronic shoulder pain caused by damage to the tendons of the rotator cuff muscles according to a 6-month open clinical study

Local injections of platelet-rich plasma (PRP) and hyaluronic acid (HLA) are considered an effective method for treating chronic shoulder pain (CSP) associated with damage to the tendons of the rotator cuff muscles (RCM).The aim of the study is to compare the effectiveness and safety of local therapy of PRP and HLA in patients with CSP caused by damage to the tendons of the RCM muscles.Materials and methods. The study included 100 patients (54% women and 46% men, average age 51.5±15.1 years) with CSP (persisting for ≥3 months) associated with damage and tendinitis of the supraspinatus, subacute, scapular or small round muscle, confirmed by magnetic resonance imaging or ultrasound (ultrasound). The patients were randomized into two groups of 50 people who were treated with PRP (three injections at 7-day intervals) or HLA (two injections at 7-day intervals). The injections were performed under ultrasound control in the subacromial SAC. The results of the study were evaluated by the dynamics of pain intensity (on a visual analog scale, up to 100 mm) and functional disorders (ASES and CSS indices) after 1, 3 and 6 months.Results. Against the background of the use of PRP and HLA, there was a significant improvement in the condition of patients, while both drugs showed approximately the same effectiveness. The severity of VAS pain decreased from 56.8±15, respectively, after 6 months.5 and 57.6±17.8 mm to 31.8±27.8 and 30.2±26.3 mm, ASES-c 55.8±15.9 and 53.6±14.7 to 74.6±22.4 and 77.3± 22.4, CSS-c 59.2±14.4 and 47.8±16.9 to 69.9±17.3 and 65.6±19.2. the Dynamics of all these indicators in comparison with the baseline level was statistically significant (p&lt;0.001). Number of patients with moderate / mild pain (&lt;40 mm VAS) after 6 months. after the introduction of PRP and HLA was 48% and 60%, requiring regular NSAID intake 30% and 28%, respectively. In all parameters, the difference in the effectiveness of PRP and HLC was not statistically significant (p&gt;0.05). The effectiveness of PRP and HLA (in terms of pain dynamics, ASES, and CSS) was significantly higher in individuals younger than 45 years, compared to older patients. The tolerability of therapy was good – after the introduction of PRP, 40% of patients had a short-term (3–4 days) increase in pain, which did not require the use of additional analgesics or interruption of treatment. No serious adverse reactions were observed when using PRP and HLA.Conclusion. OTP and GLA are effective and safe in the treatment of CSP associated with damage to the tendons of the RCM muscles. The dynamics of pain intensity and functional status after the use of these drugs did not differ. Treatment of PRP and HLA is more effective in people younger than 45 years.

Role of Platelet Rich Plasma in Chronic Plantar Fasciitis: A Prospective Study.

Autologous platelet rich plasma (PRP) local injection has been recently proposed as a treatment of plantar fasciitis. The autologous PRP does not have much side effects compared to steroid injections. So far PRP injections have shown promising results in various studies. This study assessed the efficacy of a single local injection of PRP in chronic unilateral plantar fasciitis through a prospective case series. A hospital-based prospective case series of 30 unilateral plantar fasciitis patients with symptom duration of 6months or more were included in the study. All patients included in the study were assessed clinically and by visual analogue score for heel pain, AHS component of AOFAS and FADI scores before injection and at 6 and 12week follow-up. USG measurement of plantar fascia thickness was done at pre-injection and at 12weeks follow-up. All patients were observed for 12weeks. The mean age was 39years (range 20-55years). The pre-injection VAS score for heel pain was 6.5 ± 1.1 which improved to 2.7 ± 0.5 and 1.8 ± 0.8 at 6 and 12week respectively and difference was significant (p < 0.001). The baseline FADI and AHS component of AOFAS scores were 53.1 ± 9.0 and 72.2 ± 5.7 which improved to 65.5 ± 5.3 and 76.1 ± 4.5 at 6weeks and, 77.9 ± 4.4 and 85.7 ± 4.6 at 12weeks respectively which was significant (p < 0.001). The baseline mean plantar fascia thickness was 4.9 ± 0.3mm which was significantly (p < 0.001) reduced to 3.9 ± 0.3mm at 12weeks post PRP injection. All pairwise comparisons by the post-hoc Wilcoxon signed rank test with p-value adjustment were also significant. The short-term results of single dose PRP injections shows clinical and statistically significant improvements in VAS for heel pain, functional outcome scores and plantar fascia thickness measured by USG. This study concludes that local PRP injection is a viable management option for chronic plantar fasciitis.

The Clinical Use of Platelet-Rich Plasma in Knee Disorders and Surgery-A Systematic Review and Meta-Analysis.

In recent years, the interest in biological treatment of knee lesions has increased, especially the application of platelet-rich plasma is of particular note. The number of articles evaluating platelet-rich plasma (PRP) efficacy in the recovery of knee disorders and during knee surgery has exponentially increased over the last decade. A systematic review with meta-analyses was performed by assessing selected studies of local PRP injections to the knee joint. The study was completed in accordance with 2009 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A multistep search of PubMed, Embase, Cochrane Database of Systematic Reviews, and Clinicaltrials.gov was performed to identify studies on knee surgery and knee lesion treatment with PRP. Of the 4004 articles initially identified, 357 articles focusing on knee lesions were selected and, consequently, only 83 clinical trials were analyzed using the revised Cochrane risk-of-bias tool to evaluate risk. In total, seven areas of meta-analysis reported a positive effect of PRP. Among them, 10 sub-analyses demonstrated significant differences in favor of PRP when compared to the control groups (p < 0.05). This study showed the positive effects of PRP, both on the recovery of knee disorders and during knee surgery; however further prospective and randomized studies with a higher number of subjects and with lower biases are needed.

Systematic Review of Platelet-Rich Plasma Use in Androgenetic Alopecia Compared with Minoxidil®, Finasteride®, and Adult Stem Cell-Based Therapy.

The number of articles evaluating platelet-rich plasma (PRP) efficacy in androgenic alopecia (AGA) have exponentially increased during the last decade. A systematic review on this field was performed by assessing in the selected studies the local injections of PRP compared to any control for AGA. The protocol was developed in accordance with the Preferred Reporting for Items for Systematic Reviews and Meta-Analyses-Protocols (PRISMA-P) guidelines. A multistep search of the PubMed, MEDLINE, Embase, PreMEDLINE, Ebase, CINAHL, PsycINFO, Clinicaltrials.gov, Scopus database, and Cochrane databases was performed to identify studies on hair loss treatment with platelet-rich plasma. Of the 163 articles initially identified, 123 articles focusing on AGA were selected and, consequently, only 12 clinical trials were analyzed. The studies included had to match predetermined criteria according to the PICOS (patients, intervention, comparator, outcomes, and study design) approach. In total, 84% of the studies reported a positive effect of PRP for AGA treatment. Among them, 50% of the studies demonstrated a statistically significant improvement using objective measures and 34% of the studies showed hair density and hair thickness improvement, although no p values or statistical analysis was described. In total, 17% of the studies reported greater improvement in lower-grade AGA, while 8% noted increased improvement in higher-grade AGA. Only 17% of the studies reported that PRP was not effective in treating AGA. The information analyzed highlights the positive effects of PRP on AGA, without major side effects and thus it be may considered as a safe and effective alternative procedure to treat hair loss compared with Minoxidil® and Finasteride®.

Platelet-rich plasma injection for the treatment of atrophic fracture nonunion

To explore clinical effects of platelet rich plasma (PRP) injection in treating atrophic fracture nonunion. From March 2015 to March 2017, 15 patients with atrophic fracture nonunion were treated with PRP injection, including 10 males and 5 females, aged from 23 to 56 years old with an average age of (40.0±9.1) years old, the time of fracture nonunion ranged from 6 to 14 months with an average of (8.87±2.45) months. Preparing PRP by extracting 60 to 100 ml peripheral blood. PRP platelet count ranged from 587 to 1 246 with an average of (947.13±158.58) ×10 9 /L. Under the perspective, 13 to 20 ml PRP were injected into the fracture end, and each injection was performed once on the first and the second week of the treatment. Complications such as whether the limb was shortened, angulation, and rotational deformity and radiological examination were observed. All patients were followed up from 6 to 12 months with an average of (6.8± 2.1) months. No shortening, angulation, and rotational deformity occurred. Thirteen patients had fracture healing, the time ranged from 4 to 6 months with an average of (4.8±0.7) months. Two patients had no completely porosis at 12 months during following up, and 1 patient occurred bolt loose. Other patients had no complications. The stability of fracture ends of atrophic fracture nonunion after internal fixation is an indication for local PRP injection. PRP treatment for atrophic fractures could completed under local anesthesia, and it has advantages of safe operation and reliable efficacy.

Effect of platelet-rich plasma on the rate of orthodontic tooth movement.

To investigate the effect of local injection of platelet-rich plasma (PRP) on the rate of orthodontic tooth movement. Sixteen female patients were randomly allocated in a split-mouth study design to receive PRP injections with CaCl2 activating solution on one side (intervention side) while the other side received CaCl2 injection only (control side). Canine retraction was performed on 0.017 × 0.025-inch stainless steel archwire applying 1.5 N retraction force. PRP and CaCl2 injections were done at 0, 3, and 6 weeks. The duration of the study was 4 months. Data were collected from digitized models. Assessment of pain accompanying the procedure was done using a visual analogue scale. The rate of canine retraction was faster on the intervention side in the first 2 months, with a statistically significant difference in the first month (P = .049). On the other hand, the rate was statistically significantly slower on the intervention side in the third month following cessation of PRP injections (P = .02). Pain increased following injections on both sides. PRP showed a positive potential to accelerate the rate of tooth movement when injected in the first 2 months. Repeated injections of PRP to maintain a steady rate of accelerated tooth movement warrant further investigation.

Platelet rich plasma injection versus extracorporeal shock-wave therapy in treatment of plantar fasciitis

Objective The aim of this study was to determine the efficacy of local platelet-rich plasma (PRP) injection compared with extracorporeal shock-wave therapy (ESWT) for treatment of plantar fasciitis. Background Plantar fasciitis is an important cause of heel pain. ESWT and PRP have emerged as new management options, alternative for surgery. Patients and methods This comparative study included 60 patients, comprising 48 female and 12 male patients with plantar fasciitis diagnosed clinically and by ultrasound. The patients were divided into two groups: 30 patients received single local PRP injection and 30 patients received three sessions of ESWT weekly. All patients were assessed using pain visual analog scale (VAS) score, American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot scale, and plantar fascia thickness by ultrasound before treatment and at 1 and 3 months after treatment. Results VAS, AOFAS ankle-hind foot score, and plantar fascia thickness improved significantly in both groups. The AOFAS ankle-hind foot scale shows more improvement in the ESWT group at 1 month after treatment (P = 0.009). Significant improvement in plantar fascia thickness was seen clearly in PRP group at 1 and 3 months after treatment (P Conclusion Local PRP injection and ESWT improve pain and function in patients with plantar fasciitis. ESWT showed early improvement if plantar fasciitis is associated with calcaneal spur.

The Effect of Corticosteroid Local Injection Versus Platelet-Rich Plasma for the Treatment of Plantar Fasciitis in Obese Patients: A Single-Blind, Randomized Clinical Trial

Chronic plantar heel pain (CPHP) is one of the most common painful and disabling foot conditions, for which various treatments have been proposed. We aimed to investigate the efficacy of local injection of platelet-rich plasma (PRP) compared with the conventional method of local corticosteroid injection in obese patients who were resistant to other nonsurgical treatments. In this single-blind, randomized clinical trial, 32 obese patients with chronic plantar heel pain were randomly allocated to 2 groups of 16 participants each. In 1 group, 40 mg of dimethylprednisolone was injected once into the painful heel, whereas the other group received 3 separate injections of PRP, with each injection administered 1 week apart. The groups were compared at baseline and at 24 weeks after the injection, or course of injections, was administered. Exposures, total morning pain, and foot function index were not statistically significantly different between the groups at baseline; however, at 24 weeks after the treatment, final pain and morning pain scores were statistically significantly (p < .001) better in the corticosteroid group, and the mean foot function index scores were 65.4 ± 3.2 and 58.3 ± 2.9 (p < .001) in patients treated with corticosteroid and PRP, respectively. In obese patients with plantar fasciitis, injection with corticosteroid was more effective than PRP at reducing pain and improving function.

Clinical study of local injection of autologous platelet-rich plasma in treatment of diabetic foot ulcer

To investigate the effectiveness of local injection of autologous platelet-rich plasma (PRP) in treatment of diabetic foot ulcer. Between October 2017 and October 2018, 90 diabetic foot ulcer patients who met the selection criteria were randomly divided into 3 groups: PRP injection group (group A, PRP was injected and hydrogel dressing covered the wounds), PRP covered group (group B, PRP gel and hydrogel dressing covered the wounds), and the control group (group C, hydrogel dressing covered the wounds), 30 cases in each group. There was no significant difference in gender, age, injured side, disease duration, preoperative glycosylated hemoglobin, wound size, and Wagner grading between groups (P>0.05). The frequency of treatments and hospitalization day in all groups and the total amount of PRP application in groups A and B were recorded. The wound healing condition was recorded during the treatment, and the wound healing rate was calculated at 3 months after the first debridement. The frequency of treatments in groups A, B, and C were (10.2±0.8), (11.4±0.6), (12.5±0.5) times, respectively. The total amount of PRP application of groups A and B were (306±24) and (342±18) mL, respectively. There was no significant difference in the frequency of treatments and the total amount of PRP application between groups (P>0.05). The hospitalization days of groups A, B, and C were (40.5±1.8), (62.1±2.3), and (88.6±1.4) days, respectively, showing significant differences between groups (P<0.05). In the course of treatment, the necrosis and exudation of the wounds gradually reduced, the areas of wounds gradually reduced; and the above conditions of group A were significantly better than groups B and C, and group B was better than group C. At 3 months after the first debridement, the wound healing rates of groups A, B, and C were 93.2%±0.8%, 52.1%±1.1%, and 21.3%±1.3%, respectively, with significant differences between groups (P<0.05). PRP can effectively promote the repair of diabetic foot ulcer. The effectiveness of local injection of PRP is superior to the local coverage.

Is Platelet-rich Plasma Injection more Effective than Steroid Injection in the Treatment of Chronic Plantar Fasciitis in Achieving Long-term Relief?

Introduction: Plantar fasciitis is characterised by pain in the heel, which is aggravated on weight bearing after prolonged rest. Many modalities of treatment are commonly used in the management of plantar fasciitis including steroid injection. Many studies show that steroid injection provides pain relief in the short term but not long lasting. Recent reports show autologous platelet-rich plasma (PRP) injection promotes healing, resulting in better pain relief in the short as well as long term. The present study was undertaken to compare the effects of local injection of platelet-rich plasma and Corticosteroid in the treatment of chronic plantar fasciitis.Materials and methods: Patients with the clinical diagnosis of chronic plantar fasciitis (heel pain of more than six weeks) after failed conservative treatment and plantar fascia thickness more than 4mm were included in the study. Patients with previous surgery for plantar fasciitis, active bilateral plantar fasciitis, vascular insufficiency or neuropathy related to heel pain, hypothyroidism and diabetes mellitus were excluded from the study. In this prospective double-blind study, 60 patients who fulfilled the criteria were divided randomly into two groups. Patients in Group A received PRP injection and those in Group B received steroid injection. Patients were assessed with visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score. Assessment was done before injection, at six weeks, three months and six months follow-up after injection. Plantar fascia thickness was assessed before the intervention and six months after treatment using sonography.Results: Mean VAS in Group A decreased from 7.14 before injection to 1.41 after injection and in Group B decreased from 7.21 before injection to 1.93 after injection, at final follow-up. Mean AOFAS score in Group A improved from 54 to 90.03 and in Group B from 55.63 to 74.67 at six months’ follow-up. The improvements observed in VAS and AOFAS were statistically significant. At the end of six months’ follow-up, plantar fascia thickness had reduced in both groups (5.78mm to 3.35mm in Group A and 5.6 to 3.75 in Group B) and the difference was statistically significant.Conclusion: Local injection of platelet-rich plasma is an effective treatment option for chronic plantar fasciitis when compared with steroid injection with long lasting beneficial effect.

Synergistic Effects of Human Platelet-Rich Plasma Combined with Adipose-Derived Stem Cells on Healing in a Mouse Pressure Injury Model.

Pressure injury (PI) affects quality of life and results in economic and social burdens. Local transplantation of human adipose-derived stem cells (ASCs) is considered an effective treatment. However, ASC suspension alone is vulnerable to the immune system and results in a shortened cell survival. There is increasing evidence of a synergistic effect of platelet-rich plasma (PRP) combined with ASCs on wound healing. This study investigated the effectiveness, synergy, and mechanism of wound healing following local injection of PRP combined with ASCs in a rodent PI model. PRP or ASCs alone were the control intervention. Wound healing, inflammatory infiltration, collagen deposition, angiogenesis, neurogenesis, and cell homing were investigated. PI healing was promoted by the synergistic effects of PRP combined with ASCs. The combination was more effective than ASCs alone for modulating inflammation, increasing collagen deposition, angiogenesis, neurogenesis, and the persistence of the injected ASCs. These data provide a theoretical foundation for the clinical administration of ASCs combined with PRP in PI healing and skin regeneration.

No effect of platelet-rich plasma as adjuvant to bone marrow stimulation for the treatment of chondral defects in a large animal model.

Bone marrow stimulation (BMS) remains a dominant treatment strategy for symptomatic full thickness articular cartilage defects. Autologous platelet-rich plasma (PRP), may improve biological cartilage repair as an adjunct to BMS. To assess the histological quality of cartilage repair after BMS with and without repeated local injections of PRP for the treatment of full-thickness focal chondral defects of the knee. Two full-thickness chondral defects (Ø = 6mm) were surgically performed in the medial and lateral trochlea of each knee in skeletally mature Göttingen minipigs. The two treatment groups with 12 defect for each groups were (1) BMS with one weekly PRP injection for 4weeks, and (2) BMS alone. The animals were euthanized after 6months. Samples of both whole blood and PRP were analysed with an automated hematology analyzer to determine the concentrations of platelets and nucleated cells. The composition of cartilage repair tissue was assessed using gross appearance assessment, histomorphometry and semi-quantitative scoring (ICRS II). The average fold increase in platelets was 10.2 ± 2.2. Leukocyte concentration increased in PRP samples by an average fold change of 7.2 ± 1.3. Our macroscopic findings showed that the defects in the BMS + PRP-treated group, were filled with an irregular, partially rough tissue similar to the BMS-treated group. No significant difference in amount of hyalin cartilage, fibrocartilage or fibrous tissue content and ICRS II scores was found between the groups. Four repeated local injections of leukocyte-rich PRP after BMS in the treatment of full-thickness cartilage injuries demonstrated no beneficial effects in terms of macroscopic and histological cartilage repair tissue quality.

Efficiency of local injections of platelet-rich plasma in shoulder impingement syndrome

Chronic shoulder pain caused by shoulder impingement syndrome (SIS) is a common pathology that leads to worse quality of life and disability. The local administration of platelet-rich plasma (PRP) is a promising treatment for SIS.Objective: to evaluate the efficiency of subacromial injection of PRP in chronic shoulder pain caused by SIS.Patients and methods. The investigation enrolled 30 patients (13 women and 17 men; mean age, 45.8±14.1 years) with chronic shoulder pain lasting ≥3 months after rotator tendons injury confirmed by ultrasound and/or magnetic resonance imaging and inefficiency of previously medical therapy. All the patients received three subacromial injections of 5 ml of PRP at a 7-day interval. The investigators assessed the course of pain during movement (100-mm visual analogue scale (VAS)) and functional ability according to the ASES and CSC questionnaires at baseline and 1, 3 and 6 months after treatment.Results and discussion. During the treatment, there was a considerable improvement in all indicators. At baseline and 1 and 3 months, the mean pain severity measured on VAS was 49.3±10.3, 32.4±21.3, and 20.6±21.3 mm, respectively; in this case, the positive effect persisted at 6-month follow-up: 10 [0; 30] mm (p&lt;0.001). The mean ASES values were 59.5±11.5, 75.9±17.4, 82.6±17.6, and 86.7±17.1 (p&lt;0.001) and the mean CSC scores were 72.3±14.1, 81.0±16.2, 88.5±16.1, and 92.8±16.2 (p&lt;0.001), respectively. There were no serious adverse reactions.Conclusion. Subacromial injection of PRP is an effective and safe treatment for chronic shoulder pain associated with SIS.

The efficacy of platelet rich plasma in the treatment of resistant plantar Fasciitis-follow up of 12 months

Background: Platelet-rich plasma (PRP) has been used as an alternative therapy for plantar fasciitis (PF) to reduce heel pain and improve functional restoration. PRP has a role in the inflammatory, coagulation processes as well as immunity modulation. During the degranulation of platelets they release cytokines and other growth factors. These promote angiogenesis, help in tissue remodelling and wound healing. They may have a pain relieving effect depending on the release of proteases with analgesic properties. This is a study of 26 patients treated with PRP for the treatment of resistant PF. Objective: To compare the efficacy of local injection of PRP at different time intervals for the treatment of resistant PF.Materials and methods: In this study, 26 patients diagnosed with resistant Plantar Fasciitis, underwent local injection of PRP and were followed up at 3, 6, 9 and 12 months and VAS recorded. Results: In this study, the VAS showed significant improvement from the pre injection VAS to the VAS at 3 months, 6 months, 9 months and 12 months after injection. The difference in the VAS from 3 months to 6, 9 and 12 months post was statistically significant. The difference in VAS from 6 months to 9 months and 12 months post injection was statistically highly significant and very highly significant respectively. In between 9 months to 12 months post injection, there was no statistical significance. Conclusion: Platelet Rich Plasma provides good symptomatic relief in the treatment of Plantar Fasciitis with sustained gradual relief of pain and improving daily function and activity level. Platelet Rich Plasma proved to be effective modality in providing continuous and sustained relief of pain over a period of 12 months.

No Effect of Platelet-Rich Plasma Injections as an Adjuvant to Autologous Cartilage Chips Implantation for the Treatment of Chondral Defects.

Repair of chondral injuries using cartilage chips has recently demonstrated clinical feasibility. Autologous platelet-rich plasma (PRP) is a potential promising technique for improving healing response during cartilage repair. To assess the cartilage repair tissue quality after autologous cartilage chips treatment (CC) with and without repeated local injections of PRP for the treatment of full-thickness focal chondral defects of the knee. Two full-thickness chondral defects (Ø = 6 mm) were created in the medial and lateral trochlea facets of each knee in 6 skeletally mature Göttingen minipigs. The 2 treatment groups were (1) CC with 1 weekly PRP injection for 3 weeks (n = 12) and (2) CC alone (n = 12). The animals were euthanized after 6 months. Samples of whole blood and PRP were analyzed for concentrations of platelets and nucleated cells. The composition of the cartilage repair tissue was assessed using gross appearance assessment, histomorphometry, and semiquantitative scoring (ICRS II). Histological evaluation demonstrated no significant difference in the content of hyaline cartilage (CC + PRP: 18.7% vs. CC: 19.6%), fibrocartilage (CC + PRP: 48.1% vs. CC: 51.8%), or fibrous tissue (CC + PRP: 22.7% vs. CC: 21.8%) between the treatment groups. Macroscopic evaluation did not demonstrate any difference between groups. PRP injections after CC in the treatment of full-thickness cartilage injuries demonstrated no beneficial effects in terms of macroscopic and histologic composition of cartilage repair tissue.

Comparison of platelet-rich plasma and laser therapy in treatment of chronic lateral epicondylitis

BackgroundLateral epicondylitis (LE) is the most frequent cause of chronic lateral elbow pain in adults that represents an encumbrance on social and professional life of patients. Many treatment modalities that have been used in the management of LE have recently come into question. Platelet-rich plasma (PRP) and low-level laser therapy (LLLT) have been tried for management of chronic tendinopathies but with some debate about their effectiveness.ObjectivesThis study compared the effectiveness of local injection of PRP and LLLT in pain reduction and functional improvement in chronic LE.Patients and methodsThis randomized double-blinded, prospective study included 104 eligible patients with chronic LE. Fifty-two patients were treated with local PRP injection and 52 were treated by intermittent LLLT. They were evaluated at 3 and 6 months for subjective pain using visual analog scale (VAS), functional outcome, and grip strength.ResultsPain was assessed using the subjective VAS which was improved in both PRP and LLLT groups, DASH score and grip strength revealed improvement in both groups. This improvement was of highly statistical significance in both groups when compared with baseline evaluation (P<0.001). On comparing the PRP group with the LLLT group, there was significant improvement in VAS at 6 months only, whereas there were significant improvements in functional outcome and grip strength evaluation at 3- and 6-month follow-up for PRP group.ConclusionTreating patients with LE with PRP injection improves pain and function more effectively compared with LLLT.