PRP Injection Research Articles

Assessment of Pain and Functional Outcome between Intra-Articular Corticosteroids and Platelet Rich Plasma (Prp) in Treatment of Knee Osteoarthritis: A Prospective Observational Cohort Study

Background-Osteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient’s mobility and quality of life. Although pharmacological treatments like corticosteroids can provide immediate pain relief and enhance mobility and quality of life for osteoarthritis patients, their long-term effectiveness is limited. Material and Method- Forty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren Lawrence grades II–III) were enrolled in this study. In the study, 30 patients were assigned to the PRP group and received a 5 mL intra-articular injection of PRP, while another 30 patients were randomized to the corticosteroid group and received an intra-articular injection of triamcinolone acetonide (2 mL of 40 mg/mL) and lidocaine (3 mL of 2%). The VAS, IKDC, and WOMAC scales were used to evaluate pain and function of the target knee at baseline, 1.5 months, and 3 months after treatment.

Assessment of Pain and Functional Outcome between Intra-Articular Corticosteroids and Platelet Rich Plasma (Prp) in Treatment of Knee Osteoarthritis: A Prospective Observational Cohort Study

Background-Osteoarthritis is the most prevalent type of arthritis, which significantly impacts the patient’s mobility and quality of life. Although pharmacological treatments like corticosteroids can provide immediate pain relief and enhance mobility and quality of life for osteoarthritis patients, their long-term effectiveness is limited. Material and Method- Forty patients affected by symptomatic radiologically confirmed knee osteoarthritis (Kellgren Lawrence grades II–III) were enrolled in this study. In the study, 30 patients were assigned to the PRP group and received a 5 mL intra-articular injection of PRP, while another 30 patients were randomized to the corticosteroid group and received an intra-articular injection of triamcinolone acetonide (2 mL of 40 mg/mL) and lidocaine (3 mL of 2%). The VAS, IKDC, and WOMAC scales were used to evaluate pain and function of the target knee at baseline, 1.5 months, and 3 months after treatment

Outcomes in Regenerative Medicine for Knee Osteoarthritis

<h3>Research Objectives</h3> The current evidence regarding the efficacy of regenerative injections on the improvement of function, pain, and other related symptoms of knee osteoarthritis remains to be highly controversial. The purpose of this study was to report the clinical outcomes of individuals who have received regenerative injections for symptomatic knee OA. <h3>Design</h3> Case series. <h3>Setting</h3> The Non-Surgical Center of Texas in San Antonio, Texas (private practice). <h3>Participants</h3> Ten participants' reports were collected from the Non-Surgical Center of Texas in San with symptomatic knee OA to observe the clinical outcomes of regenerative medicine injections between 2018 to 2021. All participants were treated with PRP or prolotherapy injections. Each patient received 1 to 7 injections, in and out of series, based on medical advice, patient-reported pain, and severity of symptoms during functional activity. <h3>Interventions</h3> All participants were treated with PRP or prolotherapy injections. Each patient received 1 to 7 injections, in and out of series, based on medical advice, patient-reported pain, and severity of symptoms during functional activity. <h3>Main Outcome Measures</h3> Visual analog scale (VAS) and manual muscle testing (MMT). <h3>Results</h3> Overall, there was a statistically significant reduction in pain using the VAS (p< 0.05). However, results did not show an improvement in pain with an increased number of injections. Of the ten patients, 8 had an MMT baseline of 5/5 knee flexion and extension while the other 2 patients began at 4/5 MMT. At follow-up visits, 80% of patients demonstrated improvement in pain and strength of symptomatic knee OA. The participant perspectives expressed positive benefits from regenerative injections in regard to their overall function, pain, and quality of life. <h3>Conclusions</h3> The results suggest regenerative medicine injections are an effective conservative treatment for symptomatic knee OA. Regenerative injections appear to be beneficial for improved knee function however further studies are needed to observe long-term effects for continued benefits. <h3>Author(s) Disclosures</h3> Julie B. Barnett is the academic mentor for the project and physical therapist at the Non-Surigcal Center of Texas.

Evaluation of the effect of injectionsof both platelet-rich plasma and hyaluronic acid in patients with early knee osteoarthritis via the concentration of interleukin-1β in serum

Background Early knee osteoarthritis, which causes the degeneration of articular cartilage and subchondral bone, is a disease that worsens with time and is a major contributor to physical disability. Several inflammatory cy- tokines released by chondrocytes work in concert to trigger the production of enzymes that break down cartilage. A pro-inflammatory cytokine called interleukin-1β (IL-1 β ) accelerates cartilage breakdown after trauma, re- duces matrix production, and results in chondrocyte death. Dendritic cells and macrophages are the main sources of IL-1β. On the other hand, os- teoblasts, periodontal ligament cells, and gingival fibroblasts have the abil- ity to release IL-1β. Treatment pure- platelet rich plasma (P-PRP) effec- tiveness of transforming growth factor, platelet-derived growth factor, type I insulin-like growth factor, and the vascular endothelial growth factor is thought to be related to their release. Because of their capacity to increase matrix formation, growth factors have been widely researched for OA and cartilage regeneration. Hyaluronic acid (HA) is a glycosaminoglycan poly- mer composed of N-acetyl glucosamine and D-glucuronic acid disaccharide molecules. Early embryonic development, inflammatory, wound repair, cell differentiation, and viscoelasticity are all affected by HA, and other biologi- cal processes. Materials and Methods Elabscience kits were used to assess the serum IL-1β level. The experimental investigation included 18 control groups, 10 HA injections, and 21 pure PRP injections. age ranged from 30 to 80. The study was excluded all individuals with advanced osteoarthritis in the knee, COVID-19, diabetes, and autoimmune diseases. the time frame running from November 2021 until June 2022. Other variables in our research were age, gender, family history, use of antihypertensive medications or medica- tions for other disorders, and body mass index (BMI). Results The findings of this study demonstrate elevated IL-1β levels in patients with early KOA before treatments injection compared with the healthy control. After treatments injection, the level of IL-1β was decreased compared with before injection. Conclusions IL-1β could be one of the prognostic signs of early KOA

Comparison of clinical outcome, cartilage turnover, and inflammatory activity following either intra-articular or a combination of intra-articular with intra-osseous platelet-rich plasma injections in osteoarthritis knee: A randomized, clinical trial

BackgroundThe objective of the study was to determine the changes in clinical outcome (pain and knee activity) and assess bone/ cartilage biomarkers and inflammatory activity in persons with osteoarthritis (OA) knee following a single injection of intra-articular platelet-rich plasma (IA-PRP) and combination of intra-articular, intraosseous PRP (IA+IO-PRP). MethodsThis prospective, randomized, single-blind clinical trial was conducted at a tertiary care teaching hospital in India. Ninety-six persons with OA knee with a Kellgren-Lawrence score of 3 were randomized into three groups- Group-I (IA-PRP), Group-II (IA+IO-PRP)], Group-III, [intra-articular normal saline (IA-NS)]. The primary outcome was a visual analog scale (VAS) for pain. The secondary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), bone/ cartilage turnover biomarkers [C-telopeptide (CTX-II), N-telopeptide (NTX-I), cartilage oligomeric matrix protein (COMP), N-terminal propeptide of collagen type-IIA (PIIANP), and hyaluronic acid (HA)], ultrasonography (USG) findings of the knee joint. The outcome measures were assessed at baseline, 6, and 12 weeks of follow-up. ResultsCompared to IA-NS injection, IA-PRP and IA+IO-PRP injections significantly improved VAS-pain and KOOS scores at 6 and 12 weeks. Furthermore, both PRP groups showed a significant reduction in ESR, CRP, and CTX-II at 12 weeks following PRP injections. In addition, at 12 weeks, the IA+IO-PRP group showed a significant reduction (p=0.009) in NTX-I level. Persons in the IA+IO-PRP group reported significant reductions in the synovial-effusion and infra-patellar bursitis. ConclusionsSignificant clinical improvements were noticed following IA-PRP and IA-IO-PRP injections compared to IA-NS injections. Both PRP groups reported a significant reduction in ESR, CRP, and CTX-II levels at 12 weeks. Persons in the IA+IO-PRP group reported significant changes in u-NTX-I level and knee-USG findings.

Orthobiologic Injections for the Treatment of Hip Osteoarthritis: A Systematic Review.

The use of orthobiologics is gaining increasing interest as a minimally invasive treatment for hip osteoarthritis (OA). The aim of this study was to investigate the evidence about the safety and efficacy of these products. A systematic review of the literature was performed according to the PRISMA and Cochrane guidelines. The study quality was assessed using the RoB 2.0 for randomized controlled trials (RCTs) and the modified Coleman Methodology Score (mCMS) for all studies. A total of 20 clinical studies (735 patients) was identified, 12 on PRP injections and eight on cell-based therapies (five from bone marrow, two from adipose tissue, and one from amniotic fluid). The publication trend increased over time, with over 50% of articles published from 2019. The literature analysis showed only six RCTs, all on PRP injections. The mCMS showed an overall fair methodology (mean score 59.4). While the number of studies and their methodology are still limited, the available evidence suggests safety and overall promising results, with the treatment success being inversely proportional to the severity of OA. Further high-level controlled trials are needed before drawing more definitive conclusions on the real potential of orthobiologics for the injective treatment of patients affected by hip OA.

Single injection versus peppering injection technique with platelet rich plasma in lateral epicondylitis

Introduction: Autologous Platelet Rich Plasma injection is now widely accepted treatment in the treatment of lateral epicondylitis. Prior studies on PRP injection treatment in lateral epicondylitis have not emphasized on the injection technique used to deliver PRP to the site of maximum tenderness on lateral epicondyle. PRP can be delivered by either single injection at the point of maximum tenderness or by peppering technique at the point of maximum tenderness. Which injection technique is more effective in treating lateral epicondylitis needs to be further studied. Aims and Objective: To compare the outcome of treatment of lateral epicondylitis with PRP with single injection technique and peppering injection technique in terms of improvement in functional outcome and pain. Materials and Method: A comparative study was conducted in 62 patients with lateral epicondylitis treated with PRP injection by single injection technique (31 patients) and PRP injection by peppering injection technique (31 patients). Patients were followed up at the 2nd week, 4th week 8th week and 12th week and assessed with Patient Rated Tennis Elbow Evaluation (PRTEE) Score and Visual Analog Pain Scale (VAS) Score during follow up.

Comparison of platelets-rich-plasma vs steroids in treatment of plantar fasciitis.

Objective: To evaluate the effectiveness of Platelets-Rich-Plasma therapy against Steroid therapy in the treatment of Planter fasciitis. Study Design: Quasi Experimental study. Setting: Department of Orthopedic, Hayatabad Medical Complex, Peshawar. Period: January to June 2021. Material &amp; Methods: In which participants were divided into two groups (steroid vs PRP). A total of 61 individuals with PF who have failed to respond to conservative therapy were intervened. 31 of them received steroid injection while 30 participants received PRP. The AOFAS and the VAS scoring system were recorded pre- and post-injection phases at 4 weeks, 3 months and 6 months period to evaluate the outcomes. Statistical analyses were performed to compare between the two means. Results: In both groups, the VAS, the AOFAS, and PF thickness improved significantly after injection. However, based on the available data, there was no discernible difference in improvement between the two groups for the above-mentioned factors. Conclusion: In our study, we found that both steroid and PRP injections had no statistically significant differences in VAS and AFAS scores (post treatment), we found that both were equally beneficial in treating Planter Fasciitis.

Intra-articular platelet-rich plasma injection versus hydrocortisone with local anesthetic injections for temporo mandibular disorders.

Disorders of temporomandibular joint (TMDs) are characterised by a variety of symptoms, including discomfort in the orofacial region, muscle tenderness, restricted jaw motion and noise at the joint. Additional neurological symptoms such as headaches, vertigo, heaviness, and altered vision may also coexist with TMDs. Because prostaglandin production is a critical mediator of inflammatory reaction and is inhibited by corticosteroids, they have anti-inflammatory effects. Platelet rich plasma popularly considered as PRP is a concentration of platelets and related growth factors that may have therapeutic effects by attracting, promoting, and differentiating cells as well as redesigning tissue. 64 joints totaling 40 individuals with temporomandibular joint problems were split into two categories (Category A and Category B). PRP was applied to category A's (36 joints of 20 patients) joints, while Group B's joints received hydrocortisone combined with local anaesthetic (28 joints of 20 patients). Patients were evaluated for tenderness, , maximum inter incisal opening (MIO) and clicking sound at TMJ prior to and following treatment at intervals of one week, one month and 6 months of the first week and third month. When there was comparison of outcomes in study participants receiving injections of platelet rich plasma and study participants receiving injections of hydrocortisone with local anesthetic then it was found that although both type of study participants got reduction in pain, increased opening of mouth and reduction in clicking sound however the difference between two groups was not significant statistically. There was no statistically significant difference between injections of platelet rich plasma and hydrocortisone with local anesthetic solution regarding outcomes in disorders of temporomandibular joint, however the results were slightly better in study participants receiving platelet rich plasma injections. This study demonstrated that while treating patients with TMJ issues, local anaesthesia combined with hydrocortisone as well as intra-articular injection of PRP help in reduction in pain, increase mouth opening, and minimize joint sound. Additionally, it was discovered that intra-articular injection of PRP was more successful in treating patients in this trial than local anaesthetic combined with hydrocortisone.

Injection of Platelet Rich Plasma in the Olfactory Cleft for COVID-19 Patients With Persistent Olfactory Dysfunction: Description of the Technique.

In this paper, we described technique of platelet rich plasma injection into the olfactory cleft in a 22-year-old female with 24-month post–COVID-19 anosmia. The technique starts with the blood extraction and the isolation of PRP through a 10-min centrifugation. The supernatant was injected in nasal regions after a local anesthesia through a 0° rigid optic. Several points of .2–.5 mL were performed in the nasal septum in regard of the head of the middle turbine and in the head of the middle turbine in both sides. The baseline threshold, discrimination, and identification scores were 1, 8, and 0, and the Olfactory Disorder Questionnaire score was 51, respectively. The injection of PRP in olfactory cleft was done without complication and mild pain. The patient perception of recovery of smell sense occurred at 3-week post-injection. From this time, the smell sense progressively improved to the 2-month consultation. At 2-month post-injection, the TDI scores reached 16, 16, and 16 (48), while the Olfactory Disorder Questionnaire was 73. The injection of PRP into the olfactory cleft appears to be a safe and easiness new approach that may improve the recovery of smell sense. Future controlled studies are needed.

Platelet-derived concentrates influence human keratinocyte proliferation in vitro and induce wound healing in a prospective case series of chronic wounds of different entities in vivo.

ObjectivesSoft tissues defects can extend into the fat layer or even deeper and can cause significant clinical disadvantages like pain, infections, and loss of function. In particular, chronic wounds are difficult to treat, as split-thickness skin grafts (STSGs) have varying success rates. To improve wound healing in chronic wounds, the authors have studied the application of platelet-mediator concentrate (PMC) in a human keratinocyte culture model in vitro and of autologous platelet concentrates (PRP) in a combination with surgical procedures in vivo as second line therapy in patients with initially failed wound closure.MethodsFor in vitro testing on keratinocytes, a PMC was processed with a commercially available bedside system (ATR®, Curasan, Germany). In a clinical, nonrandomized study, five in-house patients with chronic wounds were treated using a combination of surgical debridement and autologous PRP. Time of healing as determined by epithelization as well as laser Doppler imaging to visualize blood flow was analyzed. Additionally, changes in ease of surgical wound closure were determined. Finally, the quality of life of patients was assessed using a validated questionnaire (clinicaltrials.gov # NCT03667638).ResultsIn vitro testing shows a significant effect of PMC on keratinocyte proliferation in cell culture. Clinical studies showed that patients treated with PRP had initiation of wound closure, higher blood flow after PRP injection, and easier wound closure as well as improved quality of life.ConclusionsThe injection of platelet concentrates to treat chronic wound defects presents a favorable addition to treatment where single surgical procedures have failed and may improve current therapy options.

Successful Treatment of Recalcitrant Plantar Fasciitis and Achilles Tendonitis using Platelet-Rich Plasma (PRP) Injection, Short and Intermediate Results

Category: Basic Sciences/Biologics; Hindfoot Introduction/Purpose: PURPOSE: To identify is PRP is an effective alternative to surgery to decrease pain and increase activities for patients with recalitrant plantar faciiitis and Achilles tendonitis/tendonosis after failing greater than 6 months of appropriate conservative treatment. INTRODUCTION: PRP is thought to stimulate the body's natural mechanism of growth factors to promote healing of tissues. This is thought to occur through PRP transforming a chronic inflammatory degenerative process into a 'fresh' inflammatory process. Patients who undergo surgery for recalcitrant plantar fasciitis and Achilles tendonitis/tendonosis often have extended recovery time which can adversely affect employment status and lifestyle activities. The senior author began to use PRP is his orthopedic practice in 2015 as an alternative to surgery for patients with recalcitrant plantar fasciitis and Achilles tendonitis. Methods: From 2015 to 2020, patients with recalcitrant plantar fasciitis or Achilles tendonitis (symptoms &gt;6 months and who had failed appropriate conservative measures) were given the choice to proceed with continued non-operative care vs. surgical intervention vs. a one-time PRP injection. All patients reported substantial pain affecting ADLs and recreational activities. All patients underwent preoperative MRI. Only patients with degenerative changes in the painful area on MRI were considered elegible for study inclusion. Informed consent was obtained for all participants prior to PRP injection. Subjects underwent a single PRP injection using a commercially avaialble FDA approved office based PRP centrifuge system. All PRP injections were performed by the senior author without ultrasound guidance using anatomical landmarks and the patient's maximum area of tenderness. Patient subjective assessments of success/failure of the injection and percentage of pain relief using VAS were recorded at 6-8 weeks and &gt; 1 year post injection. Results: 89 PRP injections were performed on 88 patients (33 male/56 female). The Visual Analog Scale (VAS) was used to evaluate the treatment effectiveness along with the patient's subjective description of their improvement. Initial success was defined as &gt;=50% pain decreased at 6-8 weeks post-injection. 55/89 subjects experienced relief &gt;=50% at 6-8 weeks (overall 62% success rate). The average VAS improvement at 6-8 weeks was 67% for Achilles and 72% for plantar fasciitis (PF). 70 patients were available for intermediate follow-up (either in person or telephone) at an average of 27 months post-injection (range 13 - 41 months). For patients reporting &gt;=50% continued pain relief, average VAS improvement was 83% for Achilles and 89% for PF. No patients with initial relief &gt;=50% at 6-8 weeks had recurrent/worsened symptoms at intermediate follow-up. Patients with &gt;=50% relief at 6-8 weeks trended toward further decreased pain over the next 12-24 months. Conclusion: This prospective case series study shows promising support of the short-term and intermediate-term effectiveness of PRP injection as a non-surgical treatment option for patients experiencing chronic recalcitrant plantar fasciitis and Achilles tendonitis. These results not only show a significant percentage of patients were able to avoid surgery with short term improvement in their symptoms, but the study also revealed that patients who experienced greater than 50% pain relief within the first 6 weeks after PRP injection, also showed continued improvement in their symptoms long term.

SUBENDOMETRIAL AUTOLOGOUS PLATELET RICH PLASMA INJECTION IN PATIENTS WITH UNRESPONSIVE THIN ENDOMETRIUM UNDERGOING FROZEN-THAWED EMBRYO TRANSFER

The aim of the current study was to investigate the effects of subendometrial PRP injection on endometrial thickness and pregnancy outcomes in patients with a history of unresponsive thin endometrium undergoing frozen-thawed embryo transfer (FET).

DOES PRP IMPROVE SHORT TERM FUNCTIONAL OUTCOME IN PATIENTS WITH DEGENERATIVE OSTEOARTHRITIS - A PROSPECTIVE STUDY

Introduction: Osteoarthritis is one of the leading causes of disability having high prevalence in elderly population. There is a large debate regarding usage of biologicals in treatment of OA knee. The purpose of this study is to evaluate the efcacy and safety of intra articular PRP injection in treatment of OA knee. Materials and methods: 50 patients were enrolled in this prospective non-randomized study.10 patients were lost to follow up.40 patients and 55 knees were studied .All of them received 2 doses of 5ml intraarticular PRP injection 3 weeks apart. The WOMAC scores and VAS scores at baseline, 1month, 3months and 6 months follow up are compared. Results: Out of 40 patients 25 had unilateral 15 had bilateral symptomatic osteoarthritis knee. A total of 55 knees were studied. 9 patients were males and 31 were females with mean age of 55.65yrs and mean BMI of 29.2. According to KL grading 40 knees were grade 3 and 15 were grade 4.There is statistically signicant (p&lt;0.001) decrease in VAS scores and improvement in WOMAC functional scores after 2 doses of PRP injections. No signicant adverse effects were observed. Conclusion: Intraarticular PRP injection is safe, well tolerated and effective in treatment of primary osteoarthritis. There is decrease in pain and improvement in functional outcome after 2 doses of PRP. More well designed RCT'S with large sample and long term follow up are required to establish long term effectiveness of PRP injections.

Intraosseous Infiltration of Platelet-Rich Plasma for Knee Osteoarthritis: A Systematic Review of Literature and Limited Meta-analysis.

The role of subchondral bone as a key mediator in pathogenesis of osteoarthritis (OA) is emerging and various injectable modalities are being tried to address the subchondral pathology. Intraosseous (IO) infiltrations of PRP is biological way of addressing the pathology. This review aimed to explore the role of IO PRP in OA knees. A systematic literature search was conducted on the electronic databases of PubMed, Embase, Scopus, Web of Science and Ovid for relevant articles on IO PRP with a predefined search strategy. Data from eligible studies were extracted and was analyzed. There were only five studies on the study topic which included 112 patients (112 knees) who received IO PRP injection. IO PRP was associated with significant improvements in VAS, KOOS and WOMAC scores. The most commonly reported complication was pain at injection site. Meta-analysis revealed that combined intraarticular (IA) and IO PRP were associated with significantly better WOMAC scores, compared to only IA PRP. However, VAS and KOOS scores were equivocal. IO PRP infiltration for OA knees is safe and effective and results in improved patient-reported outcome scores based on the current limited literature. However, its added advantage over only IA PRP is not well established and clear due to limited available published data.

956 Patient-Reported Outcomes After Platelet Rich Plasma Injections for Elbow Tendinopathies

Abstract Introduction Elbow tendinopathies affect 1–3% of the population, with 35–50 years old most commonly being affected. It is work-related as such can lead to significant morbidity, time off work, and affect the income of patients as well as daily activities. Non-operative management is the recommended first step however, success is influenced by patient compliance. Autologous platelet-rich plasma injections are a novel approach to managing tendinopathies however, evidence of efficacy was determined by NICE to be inadequate as such recommended more research into its use. Aim Assess patient-reported outcomes after PRP injections for management of elbow tendinopathies. Method Retrospective study of 28 patients with chronic elbow tendinopathies treated with PRP injections between 2018–2020. Pre-and Post-procedure outcomes were measured using the Oxford Elbow Score questionnaire. Average f/u duration-234 days. Results 27 patients answered the questionnaire out of 28 total patients that underwent the procedure. Of the 27 patients, 20 patients (74%) reported improvement in symptoms and were satisfied with their outcomes after one injection. Conclusions This study shows PRP injections are reasonable and efficient management for elbow tendinopathies in patients not managed medically. This helps strengthen arguments for PRP injections over steroids for tendinopathies as studies have shown that steroids have potential side effects, usually requires more than 1 injection for symptomatic relief and despite being beneficial in short term, is worse than other treatment options in the intermediate and long term for patients with tendinopathies. Our numbers also coincide with previous larger studies that showed ∼70% of patients reported symptoms improving after 1 injection.

Platelet-Rich Plasma in the Treatment of Facet Mediated Low Back Pain: A Comprehensive Review.

Facet-mediated pain is a major cause of low back pain and as a result, is a significant cause of morbidity, including disability and reduced functionality. The present investigation involved a PubMed literature review between June 1, and 2021-January 1, 2022. We systematically reviewed was carried Pubmed using the search terms "platelet-rich plasma", "inflammatory mediators", "facet arthropathy", "axial back pain", and "leukoreduction". Data extraction and quality assessment were performed by 3 independent reviewers. Out of the studies analyzed 2 were retrospective, while 1 was a prospective study. PRP injections for facet mediated or modulated pain are an alternative to conventional pharmacotherapies and interventional injections/radiofrequency. There are limited numbers of studies in world literature at present. Small number of articles in the world literature and small numbers of patients in those published studies. At present, there are limited studies in the literature; however, larger well-designed studies are warranted to precisely understand efficacy, potential side effects and best practice techniques for PRP injections for facet mediated or modulated pain.

Effectiveness of ultrasound guided platelet rich plasma injection in comparison with standard conservative treatment on improving pain and function among the athletes with partial anterior cruciate ligament injury of knee: a randomized controlled trial

Background: Anterior cruciate ligament (ACL) injuries are one of the most common ligamentous injuries of knee. Treatment options for partial ACL tear range from conservative treatment up to partial reconstruction. PRP may have enhancing effect on ACL cell viability and promotion of cell proliferation in partial tear of ACL. Thus, the purpose of this study is to determine the role of PRP on partial ACL tear.Methods: A RCT was done among athletes with partial ACL injury who visited department of Sports Medicine, RIMS, Imphal during June 2019-December 2020. Patients with MRI diagnosed grade 1 and 2 ACL injury (n=48) randomized into PRP injection plus rehabilitation, (n=24) and rehabilitation alone, (n=24) groups. The outcomes were compared using International Knee Documentation Committee (IKDC) score, Lysholm score and VAS at baseline, 1st month, 4th month, 8th month and 12th month respectively.Results: Baseline characteristics were not statistically significant. At the end of 1st month, there were statistically significant improvement in both mean difference of IKDC score (.001), Lysholm score (0.001) and VAS (0.007). At the end of 4th month, there were statistically significant improvement in both mean difference of IKDC score (0.001), Lysholm score (0.026) and VAS (0.001). At the end of 8th and 12th month, improvement in mean difference of IKDC score, Lysholm score, VAS were observed however not statistically significant.Conclusions: Ultrasound guided PRP injection along with conservative rehabilitation program might be a treatment choice for ACL partial tear.

Functional and radiological outcome of autologous platelet rich plasma in chronic plantar fasciitis: A prospective study

Plantar fasciitis is one of the most common causes of foot pain. It results from sustained stress of weight bearing - hopping, jumping, running -which results in micro trauma to plantar fascia which further leads to plantar fasciitis. It constitutes 11% to 15% of all foot symptoms. Its prevalence is 8% to 10% in general population. It commonly affects at the age of 40 to 60 years. Recently platelet rich plasma was used in treating in degeneration, muscle and tendon injuries. Hence, the present study aimed to assess the treatment outcome of autologous platelet rich plasma injection in treatment of plantar fasciitis. In this prospective study, we enrolled 35 patients with plantar fasciitis coming to OPD or casualty. Patients satisfying inclusion criteria were selected based on consecutive sampling. 11 patients responded well to conservative management and 3 patients had loss of follow up. The different scoring systems were adopted such as VAS and AOFAS for pain assessment. The thickness of plantar fascia was determined by ultrasound technique. Autologous platelet rich plasma was prepared and the same was injected. The outcome analysis was done at 2 weeks, 3 months, and 6 months; and compared with pre injection values. From pre-injection to up to post-6 months period, the VAS reduction was statistically significant (P&amp;#60;0.0001). All the time interval, the AOFAS was increased which was statistically significant (P&amp;#60;0.001). The injection was effective in reducing the thickness of plantar fascia, which was found to be statistically significant at all the time intervals (P&amp;#60;0.001). Autologous PRP injection for chronic plantar fasciitis was found to be an effective treatment modality for chronic plantar fasciitis.

Effectiveness of dextrose prolotherapy for the treatment of chronic plantar fasciitis: A systematic review and meta-analysis of randomized controlled trials.

To systematically investigate the efficacy and safety of dextrose prolotherapy for treating chronic plantar fasciitis. EMBASE, PubMed, Scopus, and Google Scholar (from inception to December 9, 2021). Comprehensive review of randomized controlled trials investigating dextrose prolotherapy for chronic plantar fasciitis was done. Two investigators independently screened the titles, abstracts, and full texts and extracted data from eligible studies. The changes in visual analog scale (VAS) pain score, foot function index (FFI), American Orthopaedic Foot and Ankle Society (AOFAS) score, and plantar fascia thickness were analyzed. Reports of complications of the procedure were collected. Eight randomized controlled trials (RCTs) were included in the meta-analysis, analyzing 444 patients in total. The subgroup analysis showed that at short-term follow-up (<6months) dextrose prolotherapy was more effective in reducing VAS pain score compared to the non-active treatment control group including exercise and normal saline solution (NSS) injection. However, there was no difference in the change of VAS pain score between dextrose prolotherapy and active treatment control group, which included extracorporeal shock wave therapy (ESWT), steroid injection, and platelet-rich plasma (PRP) injection. Dextrose prolotherapy was more effective in reducing FFI, increasing AOFAS score, and reducing plantar fascia thickness at short-term (<6months) follow-up compared to other comparators. For long-term (≥6months) follow-up, there was no significant difference in the change in VAS pain score and FFI between the dextrose prolotherapy group and other comparators. No serious complication was reported. Dextrose prolotherapy is an effective treatment of chronic plantar fasciitis to reduce pain, improve foot functional score, and decrease plantar fascia thickness at short-term follow-up. Further studies in larger populations are needed to identify the optimal treatment regimen including dextrose concentration, volume, injection site, injection technique, and the number of injections required. The long-term effects of these treatments also require further examination.