Single Platelet-rich Plasma Injection Research Articles

Platelet-Rich Plasma Injections Do Not Improve the Recovery After Arthroscopic Partial Meniscectomy: A Double-Blind Randomized Controlled Trial.

Arthroscopic meniscectomy is one of the most performed surgical procedures in orthopaedics. Different approaches have been proposed to improve patient recovery but with unsatisfactory results. Platelet-rich plasma (PRP) augmentation has been proposed as a strategy to improve the recovery after meniscectomy. To investigate the clinical benefits of an intra-articular PRP injection after meniscectomy, in terms of faster and better patient recovery. Randomized controlled trial; Level of evidence, 1. Ninety patients were randomized into a treatment group, with arthroscopic partial meniscectomy immediately followed by a 5-mL injection of autologous conditioned plasma, and a control group with partial meniscectomy alone. Patients were evaluated at baseline and at 15, 30, 60, and 180 days of follow-up with the visual analog scale (VAS) score for pain (primary outcome), as well as with International Knee Documentation Committee subjective score, Knee injury and Osteoarthritis Outcome Score subscales, Tegner score, and EuroQol-Visual Analog Scale score. Objective evaluation was performed analyzing knee range of motion and circumference and the International Knee Documentation Committee objective score. Complications, patient judgment, and satisfaction were documented as well. No major complications and an overall significant improvement in the clinical scores were observed in both groups. Overall, the comparative analysis did not demonstrate significant between-group differences in absolute values or improvements of both subjective and objective scores, as well as activity level. The improvement in terms of VAS pain score for the treatment group was significant already at 15 days (from 4.3 ± 2.5 to 2.5 ± 2.5; P = .014), while in the control group it became significant at 30 days (from 3.7 ± 2.3 to 2.0 ± 2.4; P = .004). No significant differences were observed between the 2 groups in terms of judgment of treatment results and satisfaction. A single postoperative injection of PRP was not able to significantly improve patient recovery after arthroscopic partial meniscectomy. PRP augmentation did not provide overall benefits at a short-term follow-up (6 months) in terms of pain relief, function, objective parameters, and return-to-sport activities. NCT02872753 (ClinicalTrials.gov identifier).

Effect of a single versus serial platelet-rich plasma injection on the healing of acute patellar tendon defect: an experimental study

BackgroundThere is no consensus on the frequency and timing of platelet-rich plasma (PRP) injection in tendon healing. We aimed to evaluate the effectiveness of single versus multiple PRP injections in the healing of patellar tendon defects in the experimental model, through histological and biomechanical investigation.MethodsForty-four male skeletally mature Dutch rabbits were randomly divided into the five study groups ( A, B,C, D,E). After creating a longitudinal acute patellar tendon defect on both knees (One-third the width of the patella tendon), the right legs of the rabbits were used as the intervention group and the left legs as the control groups. Animals in groups A, B, and C were euthanized on days 7, 14, and 28, respectively, after the first PRP injection. Animals in group D received the second PRP injection on day 10 and was euthanized on day 14. Animals in group D received the second and third PRP injections on days 10 and 20, respectively, and were euthanized on day 28. The outcomes were evaluated histologically (modification of Movin’s Grading) and biomechanically.ResultsThe inflammatory condition was exaggerated in groups D and E. Load at failure was higher in the non-injected side of groups D and E, while there was no significant difference between the right and left legs of the three groups A, B and C. In other word, groups with a single PRP injection were more resistant to the increasing load compared to the groups with multiple PRP injections.ConclusionsPRP improves tendon healing if injected early after injury, while its injection after the initial phase of injury hampers tendon healing. In addition, a single PRP injection seems to be more effective than multiple PRP injection. Therefore, in cases where PRP injection is indicated for tendon repair, such as acute tendon injury, we recommend using a single PRP injection during tendon repair surgery.

Platelet rich plasma injection in knee osteoarthritis: results after four years.

Background Knee osteoarthritis (KOA) is a progressive degenerative disease and a leading cause of disability worldwide. Intra-articular injection of platelet-rich plasma (PRP) is still a debatable symptomatic treatment and has provided multiple publications in literature with mixed results. Aim of the work To evaluate the short and long term effects of intra-articular injection of PRP on pain and functional status of the knee joint as measured by the Lysholm questionnaire and visual analogic pain scale (VAS). Patients and methods Twenty-one patients with primary Kellgren-Lawrence grade 3 KOA were assessed using the Lysholm questionnaire and the visual analogue scale for pain (VAS). A single PRP injection was administered, followed by reassessment of VAS at the first, fourth and eighth weeks after the injection. After eight weeks, patients were assessed with VAS and Lysholm questionnaire. In order to evaluate the long term effect of this single injection, we reassessed the patients four years after the injection using the same method. Results Fifteen females (71%) and six males (29%) with mean age 60 years (ranging from 44 to 76 years) were enrolled. After a single PRP injection, there was significant improvement in Lysholm and VAS. Before the injection, VAS medium score was 7 (ranging from 5 to 9) and we observed improvements in all assessments at the first (medium VAS 2), fourth (medium VAS 2) and eighth week (medium VAS 2) post injection and was still better than the pre injection score after 4 years (medium VAS 4). This was also observed in Lysholm score. The pre injection score was 41; at 8 weeks, 84; at 4 years, 66. Conclusion PRP injection achieves good results in the symptomatic treatment of Kellgren-Lawrence grade 3 KOA. This study confirmed that a single PRP injection can provide a long-term effect in pain reduction and functional status improvement in KOA, despite the progression of the disease. Further studies with more patients and randomized double blinded controlled studies are recommended to confirm these results.

Platelet Rich plasma injection of the vocal folds in benign vocal pathologies

PurposeThere are few options for treatment of dysphonia secondary to vocal pathology related to lamina propria scar, atrophy, sulcus, or inflammatory disorders. Platelet rich plasma (PRP) may provide anti-inflammatory and regenerative properties seen with other tissue engineering therapies without the risks associated with these treatments. We evaluated vocal fold (VF) injection of PRP for feasibility, phonatory effects, patient satisfaction and durability.MethodsPatients with dysphonia secondary to vocal fold scar, atrophy, sulcus and inflammatory lesions were included. PRP injections were administered in office, to bilateral vocal folds. Patients were followed up at 1 week, 1 month, 3 months and 6 months to assess outcomes (GRBAS scale, maximum phonation time, vocal fatigue index (VFI), voice handicap index (VHI-10) and stroboscopy).Results75 intracordal PRP injections were administered to 48 patients. All injections were completed, and no adverse reactions were experienced. Improvements in VHI-10 scores at 1,3,6 months were seen (mean VHI 21.73 at baseline, 15.62 at six months, p < 0.001). 72.3% rated improvement at 7 or above on Likert scale. 95.7% of patients would consider a future PRP injection. Secondary outcomes VFI, MPT, and GRBAS also demonstrated significant improvements over time. Patients receiving a single PRP injection (n = 26) still demonstrated significant VHI-10 improvements at 1,3 and 6 months.ConclusionsVF office PRP injections are feasible and safe and can provide phonatory benefit and reduce vocal effort in benign VF disorders. A single PRP injection is sufficient to provide sustained benefit in some cases.Level of evidenceLevel III: prospective cohort study.

Ultrasound guided platelet rich plasma injections for post-traumatic greater occipital neuralgia following concussion: a pilot randomized controlled trial.

Treatment for post-traumatic greater occipital neuralgia (GON) includes serial injections of steroid/anesthetic. While these injections can alleviate pain, effects can be transient, frequently lasting only 1 month. As a potential alternative, platelet-rich plasma (PRP) injections are an emerging biological treatment with beneficial effects in peripheral nerve disorders. We investigated the feasibility, safety, and effectiveness of a single PRP injection for post-traumatic GON in comparison to saline or steroid/anesthetic injection. In this pilot randomized, double-blinded, placebo-controlled trial, 32 adults with post-traumatic GON were allocated 1:1:1 to receive a single ultrasound-guided injection of (1) autologous PRP (2) steroid/anesthetic or (3) normal saline. Our primary outcome was feasibility (recruitment, attendance, retention) and safety (adverse events). Exploratory measures included headache intensity and frequency (daily headache diaries) and additional questionnaires (headache impact, and quality of life) assessed at pre-injection, 1 week, 1 month, and 3 months post-injection. We screened 67 individuals, 55% were eligible and 95% of those participated. Over 80% of daily headache diaries were completed with 91% of participants completing the 3-month outcome questionnaires. No serious adverse events were reported. There were no significant differences between groups for headache intensity or frequency. Headache impact on function test-6 scores improved at 3 month in the PRP (β = -9.7, 95% CI [-15.6, -3.74], p = 0.002) and saline (β = -6.7 [-12.7, -0.57], p = 0.033) groups but not steroid/anesthetic group (p = 0.135). PRP is a feasible and safe method for treating post-traumatic GON with comparable results to saline and steroid/anaesthetic. Further trials with larger sample sizes are required.Clinical trial registration:https://clinicaltrials.gov/, identifier NCT04051203.

A Single Injection of Platelet-Rich Plasma Injection for the Treatment of Stress Urinary Incontinence in Females: A Randomized Placebo-Controlled Trial

ObjectiveTo determine the efficacy of a single injection of platelet-rich plasma into the anterior vaginal wall at the mid-urethra compared to placebo, as there is emerging evidence that platelet-rich plasma may help treat female stress urinary incontinence. MethodsThis was a single-blind, randomized, placebo-controlled clinical trial at a single institution. Females with bothersome, demonstrable stress-predominant urinary incontinence were enrolled. Participants were randomized to either injection of 5 mL autologous platelet-rich plasma or saline at the anterior vaginal wall at the mid-urethra. The primary outcome was composite treatment success at six months, defined as a negative cough stress test and an answer of “much better” or “very much better” on the Patient’s Global Impression of Improvement. ResultsFifty patients were enrolled in the study and randomized to the platelet-rich plasma group (n = 25) or the saline placebo group (n = 25). There was no statistically significant difference in the primary outcome between the two groups. Adverse events were minor, and the rate of adverse events was similar between both groups. ConclusionsIn this randomized placebo-controlled study, we were unable to demonstrate a difference in stress urinary incontinence treatment success between platelet-rich plasma and saline injections. At this time, there is insufficient evidence to offer a one-time platelet-rich plasma injection into the anterior vaginal wall for treatment of female stress urinary incontinence.

The varying clinical effectiveness of single, three and five intraarticular injections of platelet-rich plasma in knee osteoarthritis

ObjectiveTo investigate the variations in clinical effectiveness among patients diagnosed with knee osteoarthritis who underwent intra-articular administration of platelet-rich plasma using single, triple, or quintuple injections.MethodsOne hundred twenty patients with grade I-III knee osteoarthritis were randomly assigned to three groups: PRP1 group, who received a single injection of platelet-rich plasma; PRP3 group, who received three PRP injections one week apart; PRP5 group, who received five PRP injections one week apart. The patients’ conditions were evaluated using the Visual Analogue Scale (VAS) and the Western Ontario and McMaster Universities Arthritis Index-VA3.1 version (WOMAC-VA3.1) at baseline and 6, 12, 24, and 52 weeks 52 weeks follow up.ResultsOut of the total participants, 106 patients (30 males and 76 females) completed the study. The primary outcome measure, WOMAC pain score, registered significant improvements across all groups when compared to pre-treatment levels. However, the application of 3 and 5 injections of platelet-rich plasma was substantially more effective than that of a single injection in reducing knee pain and stiffness, as well as enhancing physical function in patients with knee osteoarthritis. No statistically discernable difference was observed between PRP3 and PRP5 at all follow-up intervals, and there was no discernable difference between 3 and 5 PRP injections either. Mild side effects occurred in all three groups.ConclusionsThe administration of three or five injections of platelet-rich plasma is safe, substantially more effective than single injections, and leads to remarkable clinical improvement by significantly reducing knee pain, improving joint stiffness, and enhancing physical function in patients with grade I-III knee osteoarthritis. Furthermore, no significant difference was observed in the efficacy of three or five injections. Therefore, we recommend using three injections of PRP in the treatment of patients with knee osteoarthritis of grade I-III.

Microfragmented Adipose Tissue Is Equivalent to Platelet-Rich Plasma for Knee Osteoarthritis at 12 Months Posttreatment: A Randomized Controlled Trial.

Platelet-rich plasma (PRP) is an effective treatment for knee osteoarthritis (OA). Microfragmented adipose tissue (MFAT) is another orthobiologic that holds promise, but data supporting its use are limited. Previous studies showed that MFAT created using the Lipogems device was equivalent to PRP created via noncommercial laboratory-based processes. To perform a comparison of commercially available MFAT and PRP systems for treatment of knee OA. Randomized controlled trial; Level of evidence, 2. A total of 71 patients with symptomatic knee OA (Kellgren-Lawrence grades 1-4) were randomized to receive a single injection of either leukocyte-rich PRP (Angel; Arthrex) or MFAT (Lipogems) under ultrasound guidance. Patient-reported outcomes (Knee injury and Osteoarthritis Outcome Score [KOOS], visual analog scale for pain with activities of daily living [VAS pain], and Tegner activity level) were recorded at baseline and at 1, 3, 6, and 12 months after injection. The primary outcome was the KOOS-Pain subscale score at 12 months after injection. Overall, 49 patients completed their 12-month follow-up (PRP group, n = 23; MFAT group, n = 26). All demographic features were similar between groups, except that more men were randomized to the PRP group and more women to the MFAT group. At 12 months posttreatment, KOOS-Pain scores improved in both groups, with no significant group difference (PRP, 78 ± 17.9 vs MFAT, 77.8 ± 19.3; P = .69). Similarly, other KOOS subscales, VAS pain scores, and Tegner scores improved at 12 months, with no differences between treatment groups. Both PRP and MFAT injections for knee OA resulted in improved patient-reported outcomes at 12 months posttreatment, with no differences found between treatments. NCT04351087 (ClinicalTrials.gov identifier).

Combined laser-activated SVF and PRP remodeled spinal sclerosis via activation of Olig-2, MBP, and neurotrophic factors and inhibition of BAX and GFAP

A single injection of platelet-rich plasma (PRP) or stromal vascular fraction (SVF) in treating neurological ailments suggests promise; however, there is limited evidence of the efficacy of combination therapy. This trial aimed to determine whether combining SVF and PRP could provide further therapeutic effects in treating multiple sclerosis (MS). Fifteen Persian cats were separated into three groups (n = 5): group I (control negative), and group II (control positive); EB was injected intrathecally into the spinal cord and then treated 14 days later with intrathecal phosphate buffered saline injection, and group III (SVF + PRP), cats were injected intrathecally with EB through the spinal cord, followed by a combination of SVF and PRP 14 days after induction. Therapeutic effects were evaluated using the Basso–Beattie–Bresnahan scale throughout the treatment timeline and at the end. Together with morphological, MRI scan, immunohistochemical, transmission electron microscopy, and gene expression investigations. The results demonstrated that combining SVF and PRP successfully reduced lesion intensity on gross inspection and MRI. In addition to increased immunoreactivity to Olig2 and MBP and decreased immunoreactivity to Bax and GFAP, there was a significant improvement in BBB scores and an increase in neurotrophic factor (BDNF, NGF, and SDF) expression when compared to the positive control group. Finally, intrathecal SVF + PRP is the most promising and safe therapy for multiple sclerosis, resulting in clinical advantages such as functional recovery, MRI enhancement, and axonal remyelination.

Platelet-rich plasma treatment for knee osteoarthritis: A systematic investigation

According to indicates, “platelet-rich plasma (PRP)” is efficient, including secure biological technique for handling knee “osteoarthritis (OA)." Considering the number of injections necessary to see the beneficial impact, however, an agreement has yet to be reached. The therapeutic effectiveness of a single PRP injection versus numerous injections in "randomized controlled trials (RCTs)" for OA knee. To examine the impact of single vs. many treatments of PRP for suffering and functioning in patients with knee OA, extensive searching was done for RCTs published between 1970 and 2019. The information systems “MEDLINE, Scopus, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials” were searched. Data on patients, interventions, comparisons, and meaningful outcomes were collected using a data extraction tool to contain research bibliographic material. The statistics regarding the immediate results were combined using a random effects framework. With a low-moderate risk of bias and 301 patient reports, we considered clinical studies. Six months following the treatment, a synthesis revealed no substantial variations between solo and repeated injections about suffering relief standardized, average variance. The effectiveness of the knee significantly improved after numerous injections. The considerable boost was only discernible for the outcomes of solo vs. multiple pills, according to a sub-analysis. Our findings showed that a single PRP injection was just as successful in reducing inflammation as numerous treatments. However, after six months, several therapies appeared more beneficial than a single injection in improving joint functioning. The available data still needs to be improved, and further study on this subject is necessary to support our findings.

Efficacy of Intra-articular Concentrated Growth Factor, Platelet-Rich Plasma, and Hyaluronic Acid in Knee Osteoarthritis: A Comparative Analysis

Objective: Knee osteoarthritis (KOA) is a prevalent chronic joint condition causing substantial pain and disability. In recent years, intra-articular injections of platelet-rich plasma (PRP), concentrated growth factor (CGF), and hyaluronic acid (HA) have emerged as promising KOA therapies. We aimed to compare the effects of intra-articular CGF, PRP, and HA in KOA patients. Materials and Methods: Patients diagnosed with KOA and who were grade 2-3 according to the Kellgreen-Lawrence classification in radiological imaging were included in the study. Patients were randomized into three groups receiving a single injection of either HA, PRP, or CGF. Patients were evaluated for pain scores using the visual analog scale (VAS) and for pain, stiffness, and physical function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) before and 1 and 6 months after the procedure. Results: Of 60 patients, 41 were female and 19 were male. According to the Kellgren-Lawrence classification, 27 patients had grade II and 33 patients had grade III KOA, with a similar distribution among the three groups. The VAS scores showed a statistically significant decrease in all groups at 1-month and 6-month follow-up compared to pre-procedural scores. However, there was no significant difference among the groups in terms of VAS scores. The WOMAC-pain, -stiffness, -physical function scores also showed a significant decrease in all groups at 1-month and 6-month follow-up compared to pre-procedural scores. The CGF group had the lowest WOMAC scores at both time points, with a statistically significant difference compared to the PRP group (p&lt;0.05). Patient satisfaction rates were high in all groups, while the satisfaction rate was highest in the CGF group. Conclusion: CGF demonstrated superior pain alleviation and functional improvement compared to PRP and HA. Although the results of this study demonstrate the potential of regenerative treatments for KOA, more research with larger samples and longer follow-up is needed for robust validation. Additionally, the standardization of treatment protocols is important.

FRI437 Regenerative Treatment With Platelet-rich Plasma In Patients With Refractory Erectile Dysfunction: The Predictive Value Of Mean Platelet Volume

Abstract Disclosure: D. Francomano: None. S. Iuliano: None. R.A. Condorelli: None. R. Cannarella: None. S. La Vignera: None. A.E. Calogero: None. E.A. Greco: None. G. Antonini: None. A. Aversa: None. Objective: Refractory erectile dysfunction (ED) is a common disorder in men regardless of the presence of late-onset hypogonadism. Being rich in growth factors, chemokines, and angiogenic factors, platelet-derived biomaterials contained in platelet-rich plasma (PRP) are particularly useful as some of the major therapeutic regenerative agents. PRP plays a crucial role in nerve cell regeneration, axon myelinization, progenitor cell homing and migration, and anti-fibrosis and anti-apoptosis of damaged cavernous nerve, and vascular corporal tissues (J Endocrinol 2001;170:395). Based on these findings, this study aimed to evaluate whether the mean platelet volume (MPV) may predict the efficacy of PRP before its intracavernous injection in patients with ED poorly responsive to phosphodiesterase type 5 inhibitors (PDE5i) and normal testosterone levels. Methods: 150 ED patients [age: 51±16.7 years; mean international index of erectile function (IIEF)-5: 12±2.6; mean peak systolic velocity (PSV): 32±5.5 cm/sec; and MPV=9.3±1.1 fl) underwent a single-shot treatment of PRP for their inability to respond to oral PDE5i. All patients were evaluated at baseline for MPV, at baseline and 1 month after intracavernous PRP injection for IIEF5, and dynamic penile duplex ultrasound (d-PDU) according to our previously published procedure (Andrology, 2021; 9:1457). Results: All patients had a significant improvement in ED symptoms (IIEF5: 12±2.6 vs. 19±3.0; p&amp;lt;0.0001) and a significant improvement in d-PDU (PSV: 32±5.5 vs. 42±7.6 cm/sec; p&amp;lt;0.0001). ROC curve analysis showed a significant accuracy (72.1%, C.I. 64.0 - 80.2, p&amp;lt;0.0001) for MPV in identifying clinically PRP-responsive patients with favorable outcomes (≧ +4 points in the IIEF5 score). In particular, an MPV &amp;lt;8.95 was recognized as the best threshold with a sensitivity of 90% and a specificity of 54.1%. Conclusion: This study provides the first evidence that the efficacy of a single PRP injection correlates with baseline MPV in patients with ED and poor response to PDE5i. An MPV value of less than 8.95 fl. identifies patients with a lower response to treatment who could benefit from re-treatments with more PRP injections. Presentation: Friday, June 16, 2023

The Single Intra-Articular Injection of Platelet-Rich Plasma vs. Non-Steroidal Anti-Inflammatory Drugs as Treatment Options for Canine Cruciate Ligament Rupture and Patellar Luxation.

Cranial cruciate ligament rupture (CCLR) and patellar luxation (PL) are common pathologies affecting canines. Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used as a non-surgical treatment plan in these cases. Clinical usage of platelet-rich plasma (PRP) is an emerging area of interest in veterinary medicine. There is a lack of studies comparing those two different treatment methods in veterinary medicine. The main purpose of this study was to evaluate and compare the use of oral NSAIDs and single intra-articular injection of PRP on treatment outcomes in cases of canine CCLR and PL. Dogs diagnosed with CCRL (n = 12) and PL (n = 10) were subgrouped by the severity of pathologies and administered treatment: half of the CCRL and PL groups were orally administered NSAIDs and supplements for 14 days, and the other half received a single intra-articular PRP injection into affected stifle joint. We measured serum TNF-α levels and clinical outcomes (lameness scores, painfulness to manipulations, goniometry of stifle joint in flexion and extension, and muscle strength) before treatment, at day 14 and day 28 of treatment. The results of TNF-α concentration indicates a significant difference between groups of differently treated partial CCLR groups on d14 (p = 0.006). Results of group CCLR-P1 on d14 were decreased, while results of group CCLR-P2 on d14 were increased. When comparing TNF-α concentration between all CCLR cases treated with NSAIDs and treated with PRP, there was a significant difference between those groups on d14 (p = 0.001). The results of TNF-α concentration indicates a significant difference between groups of differently treated PL-III on d28 (p = 0.036). Results of group PL-III1 indicate growth of TNF-α concentration, while at the same d28, results of group PL-III2 indicate decreased levels of cytokine, comparing results between the subgroups at the same time point and within subgroups from baseline. Results indicate a significant difference in muscle strength between group CCLR-P1 and group CCLR-P2 on d28 (p = 0.007), indicating an increment in muscle strength in group CCLR-P1 up to d14 and its reduction up to d28, and muscle strength of group CCLR-P2 increasing up to d28. When comparing the muscle strength between all CCLR cases treated with NSAIDs and treated with PRP, there was a significant difference between those groups on d28 (p = 0.007). In conclusion, a single intra-articular injection of PRP has a superior effect on management of inflammatory processes, has better clinical outcomes, and longer duration of action than oral NSAIDs, in the treatment of canine CCRL or PL.

How Does Platelet-Rich Plasma Injection in Ovaries of Poor Responders Affect the Retrieved Oocytes, and Anti Mullerian Hormone: A Clinical Trial.

Platelet Rich Plasma (PRP) is proposed to have important role in cell division and proliferation, angiogenesis and health. This study evaluates the effect of a single injection of autologous PRP on ovarian response markers in women with poor ovarian response (POR). This non-randomized clinical trial was conducted between August 2020 and September 2021. Fifty six women with Bologna criteria for POR willingly chose to participate in one of the following groups: PRP for one cycle in the time of oocyte pickup (OPU) (intervention group, n= 34) or control group (n=22).The primary outcomes were: number and quality of oocytes in coming 2 cycles of ICSI, and Anti Mullerian Hormone (AMH) level two months after PRP injection. The secondary outcomes were the number and quality of embryos and chemical pregnancy rate after embryo transfer. A total of 45 participants continued the study, of which 23 were in the intervention group and 22 in control group. There were no demographic differences between two groups. At a two cycle follow up, PRP group experienced a significant improvement in AMH level and there was no respective change in control group. In one year follow up the overall pregnancy rates were same in both groups (3% Vs. 0, p=.60), while there was no difference in cumulative number and quality of embryos. PRP injection can improve ovarian reserve marker without adverse effects. Further evidence is required to evaluate the impact of PRP on assisted reproduction outcomes.

Gluteal Tendon Tear Healing on Ultrasound 10 Weeks Following a Single Platelet-Rich Plasma Injection: A Case Report

Tendinosis with or without tendon tear is a common form of tendon pathology and should be managed differently from inflammatory tendinitis although both are termed tendinopathy. The current tendinopathy management involves rest, icing, a brace, oral anti-inflammatory medicine, and physiotherapy. Should that fail a trial of Corticosteroid (CS) injection allow surgery as a last resort. This article presents a middle-aged male, a human resources manager who suffered two occasions of tendinopathy with the first one being a gradual development of symptomatic right common flexor origin calcific tendinosis (golfer’s elbow) on ultrasound (USS) secondary to competitive squash that failed conservative management and USS-guided CS injection. He had a long-term symptomatic recovery after six weeks following a single autologous platelet-rich plasma (PRP) therapy. Three years later he injured his right hip following a twisting injury to the right hip/gluteal area resulted in debilitating symptoms, USS scan revealed gluteus minimus/ medius calcific tendinosis, a partial split tear of the gluteus minimus, and trochanteric bursitis. He failed physiotherapy and anti-inflammatory medicine. He elected PRP therapy over CS injection, he became symptoms free six weeks after the injection. Teen weeks post-injection USS revealed a complete resolution of gluteus minimus tendon tear and no trochanteric bursitis, no clear tendinosis features but calcifications present. This case demonstrates the use of relatively safe affordable clinic-based PRP therapy for long-term symptomatic control of tendinopathy with/without a tear. This is superior to oral anti-inflammatory and CS injections. Additionally, the healing of the tendon tear could save people from avoiding invasive surgery with its complications and long recovery time. Thanks to the regenerative healing power of the growth factors and signaling proteins in platelets that stimulate the internal mesenchymal stem cells. We recommend a large-scale randomized control trial to confirm those findings and standardization of the PRP technique, hoping regenerative medicine to become the mainstream therapy in several musculoskeletal pathologies, particularly in resistant injuries.

Transforaminal Injections of Platelet-Rich Plasma Compared with Steroid in Lumbar radiculopathy: A Prospective, Double-Blind Randomized Study.

To evaluate and compare the clinical efficacy of transforaminal steroid and platelet-rich plasma (PRP) injections in patients with discogenic lumbar radiculopathy. 60 patients were randomized to be treated with single transforaminal injection of PRP (n = 29) or steroid (methylprednisolone acetate [n = 31]). Clinical assessment was done with Visual analogue scale (VAS), modified Oswestry low back pain disability index (MODI), and straight leg raise test (SLRT). Baseline assessment of outcomes was done followed by post-intervention evaluation at 1, 3, and 6months. Both groups had similar baseline characteristics. There was a significant statistical improvement of VAS and MODI in both groups at follow-up (P < 0.05). In PRP group, minimal clinically important change (> 2cm difference of mean for VAS and > 10-point change in MODI) for both outcome scores was achieved at all follow-up intervals (1, 3, 6months), while as in steroid group, it was seen only at 1 and 3months for both VAS and MODI. On intergroup comparison, better results were seen in steroid group at 1month (P < 0.001 for both VAS and MODI), and in PRP group at 6months (P < 0.001 for both VAS and MODI) with non-significant difference at 3months (P = 0.605 for MODI and P = 0.612 for VAS). More than 90% tested SLRT negative in PRP group and 62% in steroid group at 6months. No serious complications were seen. Transforaminal injections of PRP and steroid improve short-term (up to 3months) clinical outcome scores in discogenic lumbar radiculopathy, but clinically meaningful improvements sustaining for 6months were provided by PRP only.

Comparison of Functional Outcome of Single Versus Multiple Intra-articular Platelet-Rich Plasma Injection for Early Osteoarthritis Knee.

Background Osteoarthritis (OA) is a leading cause of pain and disability and has a negative impact on patients' quality of life. Platelet-rich plasma (PRP) has emerged as a promising treatment for various orthopaedic conditions, such as tendinopathies, nonunion, and arthritis of the knee. We sought to determine whether a single intra-articular platelet-rich plasma injection has better functional and pain outcomes when compared with multiple (two) articular platelet-rich plasma injections given in the early stages of OA of the knee, measured using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) and the visual analogue scale for pain (VAS) at the sixth week, third month, and sixth month. Materials and methods The prospective observational study was conducted among patients diagnosed with early OA who presented to the Department of Orthopaedics, R. L. Jalappa Hospital and Research Centre, Kolar, Karnataka, India, between January 2020 and June 2021. A total of 64 patients were divided into: (i) S-PRP group (34 patients), which received a single PRP injection, and (ii) M-PRP group (30 patients), which received multiple (two) PRP injections, one on presentation and the second in the thirdmonth. VAS and WOMAC scores to assess functional outcomes were used at the first visit before the intervention and at the sixth week, third month, and sixth month. Results The average age of the patients was 55.26 years in the S-PRP group and 51.13 years in the M-PRP group. Both genders were equal among study participants in the M-PRP group, but 79.4% were females in the S-PRP group.In the S-PRP group, 74% had grade II OA and 26% had grade I OA. In the M-PRP group, 60% had grade II OA and the remaining 40% had grade I OA. The decreasing trend of pain and functional limitation, which was measured by VAS and WOMAC, respectively, was observed in both groups at pre-injection, sixth week, third month, and sixth month. These differences were statistically significant. The mean difference in VAS score between the pre-injection period and at six months was 4 in the S-PRP group, whereas it was 5.77 in the M-PRP group, and this was statistically significant (p-value = 0.001). Thus, multiple PRP injections have a greater response to pain reduction when compared to single PRP injections, according to the VAS score.According to the WOMAC score, there is no statistically significant difference in the treatment response with PRP injection between the S-PRP and M-PRP groups at any follow-up period. Conclusion According to the VAS score, single PRP injections have a lower pain score than multiple PRP injections until three months of follow-up, while at six months, single PRP injections have no better effect than multiple PRP injections. But multiple PRP injections have a higher reduction in the intensity of pain when compared to single PRP injections during the follow-up period. According to the WOMAC score, there is no statistically significant difference in the treatment response with PRP injection between S-PRP and M-PRP groups.

One-shot platelet-rich plasma (PRP) injection is non-inferior to extracorporeal shockwave therapy in the management of supraspinatus tendinosis

PurposeSupraspinatus tendinosis (ST) refers to the intratendinous degeneration of the supraspinatus tendon. Platelet-Rich Plasma (PRP) is one of the possible conservative treatments for supraspinatus tendinosis. This prospective observational study aims to evaluate the efficacy and safety of a single ultrasound-guided PRP injection in the treatment of supraspinatus tendinosis and to assess its non-inferiority to the widely used shockwave therapy.MethodsSeventy-two amateur athletes (35 male, mean age: 43.75 ± 10.82, range 21–58 years old) with ST were finally included in the study. All the patients underwent clinical evaluation at baseline, (T0) and at 1-month (T1), 3-month (T2) and 6-month (T3) follow-up using the following clinical scales: the Visual Analogue Scale for pain (VAS), Constant Score and the Disabilities of the Arm, Shoulder and Hand Score (DASH). A T0 and T3 ultrasound examination was also performed. The findings observed in the recruited patients were compared to the clinical results observed in a retrospective control group made up of 70 patients (32 male, mean age = 41.29 ± 13.85, range 20–65 years old) treated by extracorporeal shockwave therapy (ESWT).ResultsVAS, DASH and Constant scores significantly improved from T0 to T1; the improvement in clinical scores was kept until T3. No local nor systemic adverse events were observed. An improvement in the tendon structure was observed on ultrasound examination. PRP showed a non-statistical inferiority, in terms of efficacy and safety, compared to ESWT.ConclusionThe PRP one-shot injection is a valid conservative treatment to reduce pain, and improve both quality of life and functional scores in patients with supraspinatus tendinosis. Furthermore, the PRP intratendinous one-shot injection showed a non-inferiority in terms of efficacy at the 6-month follow-up, compared to ESWT.

Platelet-rich Plasma in Management of Anosmia (Single Versus Double Injections).

Anosmia is a common problem with a significant impact on quality of life and increased mortality. People with anosmia may not be able to fully taste foods and may lose interest in eating. This can lead to weight loss or malnutrition. Anosmia can also lead to depression because it may impair one's ability to smell or taste pleasurable foods. Platelet-rich plasma (PRP) is an autologous biologic product with anti-inflammatory and neuroprotective effects. This prospective study evaluated the role of PRP on olfactory neuroregeneration in patients with anosmia and compare the results of single and double injections. 54 patients were included in the study who had olfactory loss greater than 6months in duration, no evidence of sinonasal inflammatory disease, and no improvement with olfactory training and topical steroids. 27 patients received a single intranasal injection of PRP into the mucosa of the olfactory cleft and 27 patients received a double injections with 3weeks interval between them. The Q-Sticks Test was administered at the beginning of the study and at 1 and 3months. All patients reported a subjective improvement of their smell shortly after injection but then stabilized. At 3-month post-treatment, 16 patients improved significantly after single injection and 19 patients improved significantly after double injections. There were no adverse outcomes from intranasal PRP injections. PRP appears safe for use in the treatment of olfactory loss, and preliminary data suggest possible efficacy, especially for those with persistent loss. Further studies will help determine optimal frequency and duration of use.

Impacts of Ultrasonogram-Guided, Intra-fascial, Autologous, Activated Platelet-Rich Plasma Injection in Chronic Plantar Fasciitis: A Quasi-experimental Study.

Background Plantar fasciitis is the most common cause of foot pain. Patients with plantar fasciitis typically present with 'first step pain,'which tends to decrease with activity and worse with heavy use. This study determines the effect of ultrasound-guided, single-dose, platelet-rich plasma (PRP) injection in patients with chronic plantar fasciitis. Materials and methods It was a quasi-experimental trial carried out in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2019 to March 2022. A total of 148 patients diagnosed with chronic plantar fasciitis were selected as samples. A total of 75 patients were allocated to group A (intra-lesional injection of autologous PRP with conservative management) and 73 patients to Group B (only conservative management). Both groups of patients were allocated to conservative management with exercises, shoe modification, activities ofdaily living (ADLs) instruction, and oral paracetamol. Results This study shows that in group A, the mean visual analog scale(VAS) score significantly reduced to 1.47±0.51 after six months of single-dose PRP injection (p<0.001). In group B, the VASscorealso decreased substantially after conservative treatment. Though in groups A and B, pain reduction was significant, in group A, the pain was decreased more compared to group B and statistically significant differences were found between the two groups at the 12th week and 24th week. The foot function index (FFI) scores decreased significantly in group A after a single dose PRP injection, compared with group B treated with conventional therapy. In group A, FFI scores decreased from 49.09±5.72 to 7.67±3.41. The study revealed a significant difference between study groupsin the 12th week and 24th week regarding FFI scores. Conclusion Ultrasound-guided intra-lesional autologous PRP Injection is safe and effective and recommended in patients with chronic plantar fasciitis, especially in recalcitrant cases after the failure of conservative treatment and corticosteroid injection.