Platelet-rich Plasma Injection Group Research Articles

Ultrasound-Guided Subfascial Platelet-Rich Plasma Injections Versus Enthesis Needling for Greater Trochanteric Pain Syndrome: A Randomized Controlled Trial.

Greater trochanteric pain syndrome (GTPS) is characterized by gluteal enthesopathy involving the peritrochanteric space and associated with chronic pain and functional impairment. A corticosteroid injection in the trochanteric bursa is the usual palliative treatment for pain. However, it is important to investigate treatment options that will relieve pain in the peritrochanteric space. To compare the clinical efficacy of subfascial platelet-rich plasma (PRP) injection and enthesis needling for GTPS. Randomized controlled trial; Level of evidence, 1. A total of 92 patients (90% women; mean age, 55 years old; mean body mass index, 25.3 kg/m2) were randomly divided into a subfascial PRP injection group and an enthesis needling group. Descriptive data and radiographic measurements of the pelvis-including leg-length difference, pelvic width difference, and pelvic trochanteric index-were recorded. The primary outcome measures were the Hip Outcome Score (HOS) activities of daily living (HOS-ADL) and sports-specific (HOS-SS) subscales and the visual analog scale for pain at 3, 6, and 12 months posttreatment. In addition, we evaluated the presence or absence of ultrasound characteristics (fascia nodules, trochanteric bursa distension, and calcium deposits) over time in response to treatment. Baseline demographic and radiological characteristics were similar between the groups. The PRP group saw significantly greater improvement from baseline to 12 months posttreatment on the HOS-SS subscore compared with the needling group (32.09 [95% CI, 28.99-40.20] vs 20.52 [95% CI, 11.99-29.05]; P = .048). At 3 months, 60% of patients in the PRP group versus 33.3% in the needling group had a reduction in pain compared with a baseline of >20% (P = .040). After subfascial PRP injection, fewer patients had a fascia nodule over the trochanter and/or bursa distension (P = .006 and P = .004, respectively). The pelvic trochanteric index was predictive of HOS-ADL and HOS-SS outcomes (P = .011 and P = .022, respectively). The interaction between treatment modality and fascia nodule influenced HOS-ADL and HOS-SS outcomes (P = .021 and P = .023) as well as the interactions of treatment modality, fascia nodules, and calcifications (P = .027). Both subfascial PRP injection and enthesis needling resulted in clinical improvements, but the improvement in the HOS-SS was greater in the PRP group. NCT04231357 (ClinicalTrials.gov identifier).

Safety and efficacy of intra-articular injection of platelet-rich plasma for the treatment of ankle osteoarthritis: a systematic review and meta-analysis.

To evaluate the safety and efficacy of platelet-rich plasma (PRP) intra-articular injective treatments for ankle osteoarthritis (OA). A systematic literature search was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in PubMed, Scopus, Embase, Google Scholar, and the Cochrane library until May 2022. Both randomized and non-randomized studies were included with the assessment of the risk of bias. We recorded the participant's age, gender, type of PRP, injection volume, the kit used, and activating agent. We subsequently assessed the short-term and long-term efficacy of PRP using the functional scores and visual analog scale (VAS). We included four studies with a total of 127 patients, with a mean age of 56.1years. 47.2% were male (60/127), according to eligibility criteria. There were three cohort studies and one randomized controlled trial (RCT) study, and no study reported severe adverse events. All included studies used the Leukocyte-poor PRP. Short-term follow-up results suggested significant improvement of the American Orthopaedic Foot and Ankle Society (AOFAS) score in the PRP injection group compared to the control group (n = 87 patients; MD: 6.94 [95% CI: 3.59, 10.29]; P < 0.01). Consistently, there was a statistical difference in AOFAS score between PRP injection and control groups in the final follow-up (≥ 6months) (n = 87 patients; MD: 9.63 [95% CI: 6.31, 12.94]; P < 0.01). Furthermore, we found a significant reduction in VAS scores in the PRP groups at both the short-term follow-up (n = 59 patients; MD, - 1.90 [95% CI, - 2.54, - 1.26]; P < 0.01) and the ≥ sixmonths follow-up (n = 79 patients; MD, - 3.07 [95% CI, - 5.08, - 1.05]; P < 0.01). The improvement of AOFAS and VAS scores at ≥ sixmonths follow-up reached the minimal clinically important difference (MCID). Nevertheless, the treatment effect of AOFAS and VAS scores offered by PRP at short-term follow-up did not exceed the MCID. Substantial heterogeneity was reported at the ≥ sixmonths follow-up in VAS scores (I2: 93%, P < 0.01). This meta-analysis supports the safety of PRP intra-articular injection for ankle OA. The improvements of AOFAS and VAS scores in the PRP group at short-term follow-up do not exceed the MCID to be clinically significant. PRP injection provides significant improvement of AOFAS score and reduced pain at ≥ sixmonths follow-up. The efficacy of PRP should be interpreted with caution regarding the high heterogeneity and the scarcity of available literature, which urges large-scale RCTs with longer follow-up to confirm the potential efficacy of PRP injection for ankle OA.

Comparative effectiveness of three treatment options for slade and dodds grade III-IV scaphoid nonunion: a retrospective study

ObjectiveTo compare the clinical efficacy of open debridement screw fixation combined with bone grafting, percutaneous screw fixation, and percutaneous screw fixation combined with injection of platelet-rich plasma (PRP) for the treatment of Slade and Dodds Grade III to IV scaphoid nonunion (SNU).MethodsThis retrospective study included patients with Grade III (25 patients) and Grade IV (28 patients) SNU. They were treated with open surgery bone grafting and internal fixation (group A), percutaneous screw fixation (group B) or percutaneous screw fixation and PRP injection (group C) from January 2015 to May 2020. The fracture consolidation rate, VAS score, and Mayo wrist function score were compared across the three groups.ResultsThe consolidation rate was not significantly different among the three groups for both Grade III and IV SNU. However, patients in group C reported significantly less pain and better wrist function 7 days after surgery compared to group A and B, for both nonunion grades. At 3 months after surgery, group C had significantly better VAS and Mayo wrist scores compared to group A for both nonunion grades, and compared to group B for Grade IV SNU. At 6 and 12 months after surgery, patients with Grade IV SNU in groups A and C had significantly better VAS and Mayo wrist scores compared to group B.ConclusionThis study suggests that percutaneous screw fixation with PRP injection could be a more effective method for treating Grade IV SNU. This approach may reduce postoperative wrist pain and improve wrist function in the early stages after surgery for patients with both Grade III and IV SNU.Type of study/level of evidenceIV.

The Efficacy of Platelet-Rich Plasma Injection Therapy in the Treatment of Patients with Achilles Tendinopathy: A Systematic Review and Meta-Analysis.

Over the past few years, many studies have been conducted to evaluate the effectiveness of platelet-rich plasma (PRP) in treating musculoskeletal conditions. However, there is controversy about its benefits for patients with Achilles tendinopathy. This study aimed to investigate whether platelet-rich plasma injections can improve outcomes in patients with Achilles tendinopathy. A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, China Biomedical CD-ROM, and Chinese Science and Technology Journal databases to identify randomised controlled clinical trials that compared the efficacy of PRP injection in patients with Achilles tendinopathy (AT) versus placebo, published between 1 January 1966 and 1 December 2022. Review Manager 5.4.1 software was used for the statistical analysis, and the Jadad score was used to assess the included literature. Only 8 of the 288 articles found met the inclusion criteria. Our work suggests that: The PRP treatment group had a slightly higher VISA-A score than the placebo group at 6 weeks [MD = 1.92, 95% CI (-0.54, 4.38), I2 = 34%], at 12 weeks [MD = 0.20, 95% CI (-2.65 3.05), I2 = 60%], and 24 weeks [MD = 2.75, 95% CI (-2.76, 8.26), I2 = 87%]). However, the difference was not statistically significant. The Achilles tendon thickness was higher at 12 weeks of treatment in the PRP treatment group compared to the control group [MD = 0.34, 95% CI (-0.04, 0.71), p = 0.08], but the difference was not statistically significant. The VAS-improvement results showed no significant difference at 6 and 24 weeks between the two groups, respectively (MD = 6.75, 95% CI = (-6.12, 19.62), I2 = 69%, p = 0.30), and (MD = 10.46, 95% CI = (-2.44 to 23.37), I2 = 69%, p = 0.11). However, at 12 weeks of treatment, the PRP injection group showed a substantial VAS improvement compared to the control group (MD = 11.30, 95% CI = (7.33 to 15.27), I2 = 0%, p < 0.00001). The difference was statistically significant. The return to exercise rate results showed a higher return to exercise rate in the PRP treatment group than the placebo group [RR = 1.11, 95% CI (0.87, 1.42), p = 0.40]; the difference was not statistically significant. There is no proof that PRP injections can enhance patient functional and clinical outcomes for Achilles tendinopathy. Augmenting the frequency of PRP injections may boost the outcomes, and additionally, more rigorous designs and standardised clinical randomised controlled trials are needed to produce more reliable and accurate results.

Platelet-rich plasma's (PRP) impacts on accelerated canine movement.

To investigate the impact of platelet-rich plasma (PRP) on canine movement acceleration. Randomized clinical trial split-mouth study with a double-blind design and controlled group on 31 orthodontic patients, which had been indicated bilateral maxillary first premolar extraction. Each patient recorded clinical features, analyzed lateral cephalometric film, and evaluated the acceleration on dental models at every specific interval. The cumulative distance to the distal canines was larger for the PRP injection group than for the control group at three time points (4 weeks, 8 weeks, and 12 weeks), all of which were statistically significant. The PRP injection group's canine distal width increased from the first 4 weeks (ΔT1) to the highest in the middle 4 weeks (ΔT2 = 1.78 ± 0.11 mm/month), and then it gradually decreased in the last 4 weeks (ΔT3). The speed of the PRP-injected canine was faster than the control group by 1.51 times. PRP can accelerate the speed of canine movement in orthodontics and can be applied for severe cases, for example, impacted tooth retraction, molar protraction or retraction, and other cases.

A Prospective Study Comparing the Efficacy of Local Injection of Platelet-Rich Plasma (PRP) vs Methylprednisolone in Plantar Fasciitis

IntroductionPlantar fasciitis is a common musculoskeletal problem in Orthopaedic practice. Heel pain caused due to plantar fasciitis, if persistent, can cause distress to the patient, so the correct intervention at the right time is needed. Plantar fasciitis is also common in the rural population.ObjectivesTo compare the efficacy of local injection of platelet-rich plasma (PRP) and corticosteroid (CS) (methylprednisolone) in patients with chronic plantar fasciitis, and to evaluate the safety, side effect and complications of two different modalities of treatment.Materials and methodsThe study period was between August 2018 and September 2020. After obtaining proper written consent, 110 patients, who were above the age of 18 years and suffering from plantar fasciitis for more than three months, were included in the study. The patient characteristics including gender, age, weight, history of heel pain, duration of symptoms and types of prior treatment were noted. All the 110 patients were subjected to four parameter assessments before administration of the PRP/CS injections. Out of the 110 patients, 55 patients received PRP injection and 55 received CS - 2 ml (40 mg) methylprednisolone with 2 ml of sterile water injections. Post administration of injections, the patients' clinical, radiological, subjective and functional outcomes were assessed at the first, third and sixth month by using the Visual Analog Scale (VAS), Foot and Ankle Outcome Instrument Core Scale (FAI), Roles and Maudsley Scores (RMS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and ultrasonogram of plantar fascia thickness.DiscussionIn this study, 110 patients were screened and evaluated. Out of these 110 patients, five patients who received PRP and five who received CS were lost for follow-up. Out of the 110 patients, 59 were females and 41 were males. The majority of the patients were in the BMI range of 18.5 to 24.9, with a mean BMI of 23.6. Comparing the results in both the groups reflected an improvement in the group of patients who received PRP injections. Two patients had post-operative complications (superficial infection) in the PRP injection group, while 10 patients had post-procedure complications (five patients developed superficial infections, three patients developed skin depigmentation, and two patients had atrophy of fat pad) in the corticosteroid injections (CSI) group. Infections subsided in all the patients as observed during subsequent follow-up.ConclusionThis study shows that PRP administration is a good method of managing patients suffering from chronic plantar fasciitis, presenting with some discomfort following activity, with more than three months of symptoms and with a VAS score of more than 6 and plantar fascia thickness of 5 mm and failed conservative management. This is evidenced by a comparison of AOFAS, FAI score and thickness of plantar fascia using an ultrasonogram before and after the procedure. This study reflects better treatment outcomes with PRP injection compared to local steroid infiltration. This is the largest series of cases studied compared to other previously available studies in the literature. PRP injections may thus be used as a superior alternative to the already available treatments for chronic heel pain.

Platelet-Rich Plasma and Adipose-Derived Mesenchymal Stem Cells in Association with Arthroscopic Microfracture of Knee Articular Cartilage Defects: A Pilot Randomized Controlled Trial.

Background This study aims to compare the effects of platelet-rich plasma (PRP) alone or in combination with adipose-derived mesenchymal stem cells (AD-MSCs) in patients affected by cartilage defects, undergoing knee arthroscopic microfracture. Methods Thirty-eight patients diagnosed with a knee monocompartmental cartilage defect (Outerbridge grade IV) on the MRI, underwent an arthroscopic procedure. After the confirmation of the lesion, they all received the same bone marrow stimulation technique (microfracture) and were randomized into two groups: the first one had additional PRP injection (group A), while the second received PRP and AD-MSC injection (group B). Knee assessment and pain score were documented with Knee Injury Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) score, Short-Form (SF) 12, and Visual Analogue Scale (VAS) before the treatment and at 1, 3, 6, and 12 months of follow-up postoperatively. An additional arthroscopic procedure, performed in four patients for a subsequent meniscal lesion, let us evaluate cartilage evolution by performing a macro/microscopical assessment on cartilage biopsy specimens. Results At the 12-month follow-up, both groups showed a comparable functional improvement. The scores on the IKDC form, KOOS, pain VAS, and SF-12 significantly improved from baseline (p < 0.05) to 12 months postoperatively in both treatment groups. The four second-look arthroscopies showed a complete repair of the articular defects by smooth solid cartilage layer, with a good chondrocytic population, in both groups. A thick smooth hyaline-like cartilage with a predominantly viable cell population and normal mineralization (a form closely resembling native tissue) was observed in group B. Conclusions Modern regenerative medicine techniques, such as PRP and AD-MSC, associated with traditional arthroscopic bone marrow stimulating techniques, seem to enhance cartilage restoration ability. The preliminary results of this pilot study encourage the synergic use of these regenerative modulating systems to improve the quality of the regenerated cartilage.

COMPARATIVE EVALUATION OF EFFICACY OF PERCUTANEOUS INTRADISCAL RADIOFREQUENCY ABLATION AND PLATELET RICH PLASMA INJECTION FOR DISCOGENIC LOW BACK PAIN: A PROSPECTIVE RANDOMIZED TRIAL

Background: Discogenic pain is a common, yet underdiagnosed cause of low backache, for which a wide array of radiofrequency (RF) ablative techniques and regenerative therapies have been tried with variable results. The objective of the study was to compare pain relief and improvement in function between percutaneous intradiscal RF ablation and platelet-rich plasma (PRP) injection for the treatment of discogenic low backache. Methods: This double-blind, randomized, parallel-group interventional study was carried out in patients with chronic lumbar discogenic pain. Twenty-four patients each in percutaneous intradiscal radiofrequency (PIRF) ablation (Group R) and PRP injection (Group P) groups were analyzed. Numeric Rating Scale (NRS) and Oswestry Disability Index (ODI) were calculated before the procedure, and at 3 and 6 months after the procedure. Results: At 3 months, NRS score was significantly less in group R compared to group P ([Formula: see text]). However at 6 months, there was no statistically significant difference between NRS and ODI of both groups ([Formula: see text] and 0.369, respectively). Both NRS and ODI decreased significantly over 6 months within each group. Conclusion: No significant difference in efficacy of PIRF ablation and intradiscal PRP injection was observed at 6 months follow-up, although there was a significant improvement in pain and disability with both the procedures.

Effect of platelet-rich plasma injection combined with individualised comprehensive physical therapy on temporomandibular joint osteoarthritis: A prospective cohort study.

The effectiveness of platelet-rich plasma (PRP) injection combined with physical therapy for the treatment of temporomandibular joint osteoarthritis (TMJ-OA) has not been studied. To assess the effectiveness of PRP injection combined with individualised comprehensive physical therapy for the treatment of TMJ-OA. This prospective cohort study included 40 patients with TMJ-OA who received PRP injection or PRP injection combined with individualised comprehensive physical therapy. Pain intensity, maximum mouth opening, temporomandibular joint sounds, and the Jaw Functional Limitation Scale (JFLS) scores and imaging findings were compared before treatment and during follow-up. The pain intensity, maximum mouth opening, and temporomandibular joint sounds of the two groups significantly improved with an increase in treatment time (p<.05). The pain improvement in the combined treatment group was greater than that in the PRP injection group at 3 and 6months (p<.05). The improvement of mouth opening was better in the combined treatment group, whereas the improvement of joint sounds was better in the PRP injection group. The improvement in JFLS scores in the combined treatment group was greater than that in the PRP injection group at 6months (p<.05). The imaging improvement rates of the two groups were similar. Platelet-rich plasma injection can significantly improve pain, mouth opening, abnormal joint sound, and mandibular function in patients with TMJ-OA and has good repair effect on condylar bone defects. PRP injection combined with individualised comprehensive physical therapy can effectively control the medium- and long-term pain of patients.

A better functional outcome with platelet rich plasma compared with local steroid injection in tennis elbow

Lateral epicondylitis commonly referred to as 'tennis elbow,' is mainly observed in the 3rd and 4th decade of life in around 2% -3% of the population. Treatment modalities for lateral epicondylitis include analgesics, immobilization, tennis elbow brace, local steroid infiltration, and ultrasound therapy. Recent studies have explored the effectiveness of platelet-rich plasma (PRP) injections in lateral epicondylitis. We used the block randomization technique. Two groups were prepared with 30 patients in each group. One group of patients received PRP and the other received local steroid injection. Patients were evaluated at the time of procedure and immediately after the procedure, at six weeks, three months, and six months, using the visual analog score and Liverpool's elbow score. At the end of 6 months, follow-up patients in the PRP injection group show good clinical and functional compare to the steroid group of patients. PRP and local corticosteroid injection provide symptomatic relief in the treatment of lateral epicondylitis. PRP infiltration gives better results in pain relief and functional activities with statically significant values when compared with corticosteroid injections.

Platelet-rich plasma for androgenic alopecia: A randomized, placebo-controlled, double-blind study and combined mice model experiment.

Platelet rich plasma (PRP) has been accepted as a potential therapy for treating androgenetic alopecia (AGA). To fully clarify the underling molecular mechanisms of PRP action on hair growth and promote its clinical applications. In this study, we used mice models and protein biochip to explore the specific mechanisms of PRP regulating hair growth. Then, we performed a randomized, placebo-controlled, double-blind, half-head study of 52 AGA patients to verify the therapeutic efficacy of PRP in Chinese AGA patients. The results confirmed that PRP treatment boosted hair regrowth, accelerated hair cycling, and the effect sustained for more than one hair cycle in mice. Protein biochip evaluation confirmed remarkably upregulated β-Catenin, PDGF, and AKT signaling and repressed p53 signaling in PRP injection group. Clinically, mean hair count, density, diameter, and anagen hair ratio in PRP group showed a significant improvement at 6month comparing to control side. Overall, we elucidated the specific molecular mechanism of PRP action on hair growth and proved the therapeutic efficacy and safety of PRP in Chinese AGA patients.

Significance of platelet rich plasma (PRP) and Corticosteroid injection in management of Adhesive capsulitis of shoulder

Background: The frozen shoulder is very common problem in India and usually could occur as idiopathic or trivial injury. Management modality is usually conservative and physiotherapy because of self-limiting nature of disease. Role of corticosteroid injection are usually effective for short period time but newer Orthobiologic agent like PRP injection are equally effective and minimal and no side effect. Material and method: In our study, total 50 patients were taken of adhesive capsulitis in period October 2018 to February 2020 and divided into groups randomly and PRP injection and corticosteroid injection was given and clinical outcome was recorded. Result: In our study, female are more affected then male, usually occur in age 40 to 60-year age group. The final outcome at 3 month post injection 20% patients with excellent, 48% with good and 32% with poor outcome with PRP injection group and for CS injection group this was found as 16% excellent, 36% good and 48% poor outcome. Conclusion: We concluded PRP and MPS showed efficacy and strong evidence in support significant effect of PRP, where steroid contraindicated or refused by patient in the treatment of frozen shoulder. However, inj. Methylprednisolone has sudden onset of action because of anti-inflammatory action with respect to inj. PRP, so has better result at 1 week follow up post injection but in long term (at 3 months follow up) inj. PRP has better effect in compared to injection MPS.

308-nm Excimer Laser Plus Platelet-Rich Plasma for Treatment of Stable Vitiligo: A Prospective, Randomized Case-Control Study.

Purpose308-nm excimer laser has a confirmed treatment effect on vitiligo. Platelet-rich plasma (PRP) is an autologous preparation which contains a variety of growth factors. The effect of 308-nm excimer laser combined with PRP on vitiligo has been rarely reported. This study investigated the effect of PRP combined with 308-nm excimer laser on stable vitiligo.Patients and MethodsA total of 60 patients with localized stable vitiligo who received treatment at Beijing Friendship Hospital and Xi’an Vitiligo Specialist Hospital between May 2019 and January 2020 were consecutively enrolled. They were equally randomized into three groups according to different treatment methods: intradermal PRP injection (group I), 308-nm excimer laser alone (group II), and 308-nm excimer laser plus PRP injection (group III). All treatments lasted for 3 months. At 3 months after treatment, clinical assessments were performed in terms of the visual analogue scale (VAS) score, repigmentation response and side effects.ResultsThe VAS scores showed significant differences among the three groups (P<0.001), with the highest score in group III, followed by group II and then group I. Repigmentation responses also showed significant differences among the groups (P<0.001), and the best effect was observed in group III. No side effects were reported in any of the groups.ConclusionThe effect of PRP combined with 308-nm excimer laser on stable vitiligo is significantly better than that of PRP and 308-nm excimer laser alone. It is safe and satisfactorily tolerant.

Effectiveness of Platelet-Rich Plasma Injection in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background: To investigate the effectiveness of platelet-rich plasma (PRP) injection among patients with rotator cuff tendinopathy in comparison with sham injection, no injection, or physiotherapy alone. Methods: From the earliest records to November 1, 2018, all published or unpublished randomized controlled trial (RCTs) comparing PRP injection with a control group (sham injection, no injection, or physiotherapy alone) in patients with rotator cuff tendinopathy were included. Eligible trials were included from the search results of electronic databases including PubMed, EMBASE, Scopus, The Cochrane Library, as well as the bibliographies of relevant trials. Five RCTs were enrolled in our meta-analysis. Two authors independently assessed the quality of RCTs with the Cochrane risk of bias tool. We designated pain reduction as the primary outcome and functional improvement as the secondary outcome. Standardized mean difference (SMD) was applied for random-effect meta-analysis. Results: In the short term (3–6 weeks) and medium term (12 weeks), the effectiveness of PRP injection and control group was indistinguishable in terms of both outcomes (pain reduction and functional improvement). Nevertheless, PRP injection led to significant long-term (>24 weeks) pain relief (SMD: 0.42, 95% confidence interval (CI): 0.12–0.72, without heterogeneity). For functional improvement in the long term, PRP injection was not more effective than the control group (SMD: 1.20, 95% CI: −0.20–2.59, with heterogeneity). Conclusions: PRP injection may provide benefit over the control group (sham injection, no injection, or physiotherapy alone) in reducing pain at long-term follow-up for patients with rotator cuff tendinopathy.

A comparative study of functional outcome between platelet rich plasma injection versus steroid infiltration in plantar fasciitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Plantar fasciitis (PF) is considered as degenerative tendinopathies. Repeated micro trauma is the major etiology of these diseases. Autologous platelet rich plasma (PRP) injections are becoming more popular in the treatment of enthesopathies like PF. The growth factors in PRP cause tissue healing. We compared the result of injecting intra-lesional autologous PRP injections versus steroid infiltration in chronic PF.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective, interventional and analytic comparative study was done and 81 patients (120 heels) were included in this study and were followed up for 6 months. We assessed the outcome of each patient using visual analog score (VAS) and foot and ankle disability index (FADI) on follow-up at 1, 3, and 6 months. &lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In our study, female preponderance was seen. Left side was more common as compared to right side. Unilateral PF is more common than bilateral. The difference with in the individual group at baseline and at 1,3 and 6 months was statistically highly significant in terms of VAS and FADI (p=0.0001) But the difference in the between the two groups was insignificant for VAS and FADI at 1, 3 and 6 months.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; In our study, as there is no significant difference in VAS and FADI score between corticosteroid injection group and PRP injection group at 1, 3 and 6 months follow up. So, it’s reasonable to conclude that both are equally effective in PF. But as PRP injection comes out to be more time consuming and more costly, corticosteroid seems to be more efficient, cost and time wise. Hence, the latter should be a better choice. &lt;/p&gt;

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.

Platelet-rich plasma injection for adults with acute Achilles tendon rupture: the PATH-2 RCT

BackgroundAchilles tendon rupture (ATR) has a long healing period, which is challenging for patients and clinicians. Platelet-rich plasma (PRP) is an autologous concentration of platelets thought to improve tendon function recovery. Although preliminary research has indicated positive effects, there is, as yet, no evidence of clinical efficacy from adequately powered robust clinical trials.ObjectivesThe objectives were to determine the clinical efficacy of PRP in patients with acute ATR using an objective mechanical muscle–tendon function measure and patient-reported outcome measures (PROMs), and to determine which PRP components contribute to its mechanism.DesignThis was a multicentre, parallel-group, participant- and outcome assessor-blinded randomised controlled trial (RCT) comparing PRP with placebo. Two embedded substudies investigated the PRP’s quality and composition and its effects on healing tendon tissues.SettingThis trial was set in trauma and orthopaedic surgery departments in 19 NHS hospitals in England and Wales.ParticipantsAdults with acute ATR presenting within 12 days of injury to be treated non-surgically were eligible. Patients with platelet dysfunction or leg functional deficiency were excluded.InterventionsParticipants were randomised 1 : 1 to the PRP injection group or the placebo group (dry needle in the rupture gap) by central computer-based randomisation using minimisation, stratified by centre and age.Main outcome measuresThe primary outcome measure was the Limb Symmetry Index (LSI) of work during the heel-rise endurance test at 24 weeks. Secondary outcomes measures, collected at 4, 7, 13 and 24 weeks, were repetitions, maximum heel-rise height, Achilles tendon Total Rupture Score (ATRS), quality of life (as measured using the Short Form questionnaire-12 items version 2), pain and participant goal attainment. Needle biopsies of the affected tendon zone were taken under ultrasound guidance at 6 weeks from 16 participants from one centre. Whole blood was analysed for cell count. PRP was analysed for cell count, platelet activation and growth factor concentration. The primary analysis was intention to treat.ResultsA total of 230 participants were randomised: 114 to the PRP group (103 treated) and 116 to the placebo group (all treated). One participant withdrew after randomisation but before the intervention. At 24 weeks, 201 out of 230 participants (87.4%) completed the primary outcome and 216 out of 230 participants (93.9%) completed the PROMs. The treatment groups had similar participant characteristics. At 24 weeks, there was no difference in work LSI (mean difference –3.872; 95% confidence interval –10.454 to 2.710;p = 0.231), ATRS, pain or goal attainment between PRP- and placebo-injected participants. There were no differences between the groups in any PROM at any time point or in complication rates, including re-rupture and deep-vein thrombosis. There was no correlation between work LSI and platelet activation in PRP, or erythrocyte, leucocyte or platelet counts in whole blood or PRP. Biopsies showed similar cellularity and vascularity between groups.ConclusionsThis trial design and standardised PRP preparation gives the first robust RCT evidence about PRP’s role in managing ATR, which suggests that PRP offers no patient benefit. Equally robust evidence to investigate PRP application in tendon and soft tissue injuries is required. The 24-month follow-up will be completed in April 2020.Trial registrationCurrent Controlled Trials ISRCTN54992179.FundingThis project was funded by the Efficacy and Mechanism Evaluation programme, a Medical Research Council and National Institute for Health Research (NIHR) partnership. The trial was supported by the NIHR Biomedical Research Centre, Oxford, and the NIHR Fellowship programme.

Platelet-rich plasma in treatment of patients with idiopathic carpal tunnel syndrome.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy in the upper extremity. Treatments for CTS alternate from conservative strategies to surgical decompression of median nerve. Few studies have applied platelet-rich plasma (PRP) for treating idiopathic CTS, with acceptable success rates. Further studies are needed to reach concrete conclusion. To study the effect of PRP injection in treatment of mild to moderate idiopathic CTS. This is a randomized controlled trial in a cohort of Egyptian patients suffered from mild to moderate CTS. They were randomly divided into two groups. Group 1: patients received ultrasound guided PRP injection and group 2 patients received ultrasound guided corticosteroid injection. The outcome measures were assessed via Visual Analog Scale, the Boston Carpal Tunnel Syndrome Questionnaire, electrophysiological findings in sensory and motor functions of median nerve and morphological changes of median nerve detected by ultrasound. This study included 150 patients suffered from mild to moderate idiopathic CTS 15 did not provide the written consent and 37 participants were excluded from the study based on the exclusion criteria leaving only 98 patients to participate in the study they were divided into two groups PRP Injection Group (PRP-inj-G) - this group included 49 patients (40 females and 9 males) steroid injection Group (St-inj-G) - included 49 patients (41 females and 8 males). At the beginning of study there was no significant difference between both groups in all parameters. (a) PRP injection had significantly improved the clinical manifestations, the electrodiagnostic examination (EDX) parameters of the median nerve (MN), and the median nerve cross sectional area (m-CSA) at 1month and 3months post-injection evaluation in comparison to baseline recordings; (b) local steroid injection had significantly improved the clinical manifestations, the EDX parameters of the MN, and the m-CSA at 1month and 3months post-injection evaluation in comparison to baseline recordings and (c) PRP injection was superior to the local steroid injection in the improvement of clinical manifestations as well as the MN motor conduction velocity along the wrist-elbow segment, the sensory latency (SL) and the MN sensory conduction, this superiority was observed in third month follow-up suggesting better outcomes in long-term follow-up. Platelet-rich plasma could be effective treatment of mild to moderate idiopathic CTS and superior to corticosteroid in improving pain, function, and distal sensory latency of median nerve. Clinical Trials.gov Identifier: NCT03863873Key Points:• PRP is effective treatment of mild to moderate CTS.• PRP is superior to corticosteroids in improving pain and function in CTS.

Prospective Clinical Research of the Efficacy of Platelet-rich Plasma in the Outpatient-based Treatment of Rotator Cuff Tendinopathy.

BackgroundThe purpose of this study is to compare the clinical outcomes of the control group and platelet-rich plasma (PRP) group among the patients who failed to respond to conservative treatment as outpatient-based therapy for rotator cuff tendinopathy, and to compare the clinical results of leukocyte-poor (LP) PRP and leukocyte-rich (LR) PRP.MethodsInclusion criteria are (1) over 18-year-old, (2) patients with rotator cuff tendinopathy, no rotator cuff tear by radiologic diagnosis (ultrasonography or magnetic resonance imaging) within the last 3 months, and (3) not effective to conservative treatment for more than 1 month. Of the final 60 subjects, 33 patients in the exercise treatment group and 27 patients in the PRP injection group (LP-PRP, 13; LR-PRP, 14) were included. Clinical evaluation was carried out by assessing the outcomes of treatment using the Numeric Rating Scale pain score, the American Shoulder and Elbow Society (ASES) score, and the Constant score at baseline and at 3 and 6 months after the procedure.ResultsThere was a statistically significant difference in ΔASES3months (ASES3months-ASESfirst) score between the control and PRP groups (p=0.006). However, there was no statistical significance between LP-PRP and LR-PRP groups (p>0.05).ConclusionsThis study showed that PRP injection was more effective than exercise therapy for the first 3 months. However, there was no difference between the LP-PRP group and the LR-PRP group. Regardless of the type of PRP, clinical application of PRP injection in patients with rotator cuff tendinopathy seems to be effective in early treatment.

The effect of platelet-rich plasma injection on post-internal urethrotomy stricture recurrence

Local injection of platelet-rich plasma (PRP) is postulated to work by delivering growth factors and cytokines that recruit healer cells and enhance recovery process at the injection site. As new scar formation leads to stricture recurrence after internal urethrotomy, we proposed to improve post-internal urethrotomy stricture recurrence rate by injecting local submucosal PRP at the time of urethrotomy. From July 2015 to June 2018, 87 male patients with symptomatic bulbar urethral stricture (diagnosed by retrograde urethrography) randomized into two groups of internal urethrotomy and submucosal normal saline injection (control group, 43 patients), and internal urethrotomy with submucosal autologous platelet-rich plasma injection (PRP injection group, 44 patients). According to the endpoint, which happened sooner, each patient was followed at 3-month intervals for 2years after internal urethrotomy or until urethral stricture recurrence. Twelve-month recurrence rates were 26.82 and 9.09% in the control and the PRP injection groups, respectively (p 0.032). After 2years of follow-up, stricture recurrence was identified in 18 (43.90%) and 9 (21.95%) patients in the control and the PRP injection groups, respectively (p 0.34). In our study, submucosal PRP injection at the site of internal urethrotomy decreased the rate of stricture recurrence a year after the intervention. This protective effect lasted for 24months, at least. Submucosal PRP injection at the time of internal urethrotomy also decreased the length of stricture in case of recurrence.