Single Platelet-rich Plasma Injection Research Articles

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.

The relationship of body mass index on patient reported outcomes after platelet-rich plasma versus microfragmented adipose tissue for knee osteoarthritis: A secondary analysis of a randomized controlled trial.

Body mass index (BMI) is known to contribute to outcomes for patients with knee OA. Furthermore, BMI influences the protein expression of orthobiologic treatments like platelet-rich plasma (PRP) and microfragmented adipose tissue (MFAT). We performed a secondary analysis of the association of BMI with PROs for patients with knee OA who received either PRP or MFAT injections. Seventy-one patients with knee OA were randomized to receive a single ultrasound-guided injection of PRP or MFAT. PRP was created from 180cc of anti-coagulated blood and processed using a double-spin, buffy-coat concentration system. MFAT was created using autologous lipoaspirate that was processed according to minimal manipulation guidelines. PROs, and osteoarthritis outcome scores (KOOS) were tracked for 12-months. Forty-nine patients (PRP=23, MFAT=26) completed 12-month follow-up. KOOS- Quality of life and activity of daily living subscores were inversely correlated (both p < 0.05) with BMI in the MFAT but not PRPgroup. KOOS-Pain and Sport subscores showed a trend towards inverse correlation with BMI in the MFAT group (p = 0.07 and p = 0.06, respectively), but not PRP.Conclusion: BMI was negatively associated with PROs in patients who received MFAT injections for knee OA, but not for patients receiving PRP.

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.

Outcome of Intra-articular Injection of Total Stromal Cells and Platelet-Rich Plasma in Primary Knee Osteoarthritis: A Randomized Clinical Trial.

Mesenchymal stem cell (MSC) therapy appeared promising in knee osteoarthritis (OA). We examined if a single intra-articular (IA) autologous total stromal cells (TSC) and platelet-rich plasma (PRP) injection improved knee pain, physical function, and articular cartilage thickness in knee OA. The study was performed in the physical medicine and rehabilitation department of Bangabandhu Shaikh Mujib Medical University, Dhaka, Bangladesh. Knee OAwasdiagnosed according to the American College of Rheumatology criteria and randomly assigned to treatment (received TSC and PRP) and control groups. Kallgreen-Lawrance (KL) scoring system was used to grade primary knee OA. The Visual Analogue Scale (VAS, 0-10 cm) for pain, WOMAC (Western Ontario and McMaster Universities Arthritis Index) for physical function, and medial femoral condylar cartilage (MFC) thickness (millimeters) under ultrasonogram (US) were documented and compared between groups before and after treatment. Statistical Package analyzed data for Social Scientists (SPSS 22.0; IBM Corp, Armonk, NY) was used for data analysis. Pre- and post-intervention outcomes were measured using the Wilcoxon-sign test, whereasMann-Whitney U-test calculated the difference between groups; a p-value <0.05 was considered statistically significant. Result:In the treatment group, 15 received IA-TSC and PRP preparation, and in the control group, 15 patientsreceived no injection, but quadricep muscle-strengtheningexercise. There was no significant difference betweengroups regarding VAS for pain, WOMAC physical function, and cartilage thickness before starting the treatment andtwo weeks after intervention. VAS for pain and WOMAC physical function scores improved profoundly in the treatment group after 12 and 24 weeks of intervention; the pain and physical function scores difference between groups was also significant. However, significant mean femoral cartilage thickness was not changed until the end of 24 weeks(U=175.00, p=0.009 two-tailed and U= 130.00, p=0.016 two-tailed, respectively, for right and left knee). Single TSC and PRP injection reduces knee pain and improves physical function and cartilage thickness in knee OA. While pain and physical function improvement happen earlier, cartilage thickness changetakes more time.

Use of combined shockwave therapy and platelet-rich plasma injection for management of chronic plantar fasciitis in runners: two case reports

Plantar fasciitis is one of the most common causes of foot and heel pain in adults. Extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) have each been described as effective treatments for plantar fasciitis; however, the combined use has not been adequately described. This report characterizes successful return to sport in two runners with plantar fasciitis who were treated with ESWT combined with PRP. Patient-reported outcomes were measured using the Foot and Ankle Ability Measure (FAAM). A 69-year-old female had 8 months of pain refractory to physical therapy (PT). A 73-year-old male presented with recent onset of 3 weeks of symptoms. Both runners had exam findings of plantar fasciitis and MRI confirmation. Each elected to complete ESWT along with PT using a foot core program and met functional improvements for both sport and ADL subscales of FAAM after initial ESWT treatment. However, each runner had worsening pain when attempting to run and both elected to proceed with a single leukocyte-poor PRP injection combined with ESWT. This allowed for successful return to running. Both cases highlight how combined ESWT and PRP with a foot core PT progression may be effective in managing plantar fasciitis in running athletes.

Comparison of the Efficacy of Intra-articular Platelet-rich Plasma with Intra-articular Steroid in the Management of Pain due to Sacroiliac Joint Dysfunction

Background: Platelet-rich plasma (PRP) has proved to be beneficial due to its remodeling property in various conditions in the past. When given intra-articularly, it may also provide adequate analgesia in low back pain. Aims: This study was aimed to compare the efficacy between intra-articular sacroiliac joint (SIJ) injection of PRP and steroid in the management of SIJ dysfunction pain. Materials and Methods: This prospective, randomized parallel group study was conducted for 24 months period at a tertiary care hospital. A total of 50 patients above 18 years were included in the study and allocated into two groups (n = 25) by computer randomization. Patients in the respective group received sacroiliac intra-articular injection of either autologous PRP or triamcinolone (steroid). For the primary outcome, the Numerical Rating Scale Score was recorded preprocedure and postprocedure at the 24 h, 1st, 3rd, and 6th month. The need for any rescue analgesia or repeat injection during the study period was considered the secondary outcome. Results: At the 1st, 3rd, and 6th month postprocedure, 100%, 88%, and 76% of patients, respectively, obtained significant pain relief after injection of PRP. In contrast, at 3rd and 6th month postprocedure, only 20% and 28%, respectively, had short-term pain relief in the steroid group. Conclusions: Single intra-articular injection of PRP provides significant pain relief and functional improvement in patients with SIJ pain.

Does Single Intra-Articular Plasma-Rich Plasma (PRP) Injection for Temporomandibular Joint (TMJ) Internal Derangement Relieve Joint Pain?

Introduction: The temporomandibular disorder (TMD) is a common pathological entity and is found in 31% of the adult population. Different minimally invasive techniques, such as the injection of diverse substances into the joint, arthrocentesis have exhibited good clinical results and such modalities would be considered either for severe TMDs or after the failure of conservative treatments. Several studies endorsed intra-articular injections of platelet- rich plasma (PRP) as an effective procedure to decrease TMD tenderness. The primary aim of this study is to assess the effectiveness of a single PRP injection in terms of reducing pain, and improving mandibular motion in patients affected by internal derangement of the TMJ. Materials &amp; Methods: The study consisted of 10 patients who reported to the oral and maxillofacial surgery clinic with painful dysfunction of the temporomandibular joint who received a single injection of PRP in the TMJ. Variables measured including pain score and mouth opening were assessed preoperatively and postoperativel. SPSS 24.0 was used for data management and statistical analysis. The level of significance was set at 0.05 for all statistical tests using chi-square. Results:The group of 10 patients consisted of 9 women and 1 man. The age of the participants ranged from 27 to 75 years, and a median age of 45.5. Upon the follow up visit within 1-3 months: 7/10 patients showed a significant reduction of the pain intensity (more than 50% reduction of pain intensity), 2/10 patients showed a partial resolution of the symptoms with minimal reduction of pain and one patient showed no improvement in either pain or mouth opening and subsequently underwent arthrocentesis. The PRP injections were successful in decreasing pain intensity scores to below 5 in most cases. A Chi-squared test was performed to test for an association between the PRP injections and pain intensity score and the outcome supports the conclusion that there is a strong correlation between the PRP injection and pain and that it is statistically significant. Conclusions:TMD symptoms and movement limitations disrupt everyday life and in cases with severe illness, studies showed that the conservative treatment measures lead to insignificant or low improvement in quality of life. For this reason, a fast acting and effective method of reducing pain and movement limitations is essential and our study findings support the role of PRP injections. It exhibited a very strong negative relationship, which indicates that the PRP injection and pain scores are inversely related.

Comparison of Clinical and Functional Outcomes after Platelet-Rich Plasma Injection and Corticosteroid Injection for the Treatment of de Quervain's Tenosynovitis.

Background Platelet-rich plasma (PRP) has local anti-inflammatory actions, which is being used as a treatment in various tendinopathies. Purpose The aim of the study is to compare the clinical results of PRP injection and corticosteroid injection in the management of de Quervain's tenosynovitis (DQTSV). Patients and Methods In this prospective study, 60 patients of DQTSV, fulfilling the predefined inclusion and exclusion criteria, were randomised into two groups. In group 1 ( n = 30), patients received a single injection of autologous PRP and in group 2 ( n = 30) they received a single injection of corticosteroid (methylprednisolone). All patients were followed up at 1 month, 3 months, 6 months, and 1 year for evaluation by Finkelstein test, visual analogue scale (VAS), DASH (Disabilities of the Arm, Shoulder and Hand) score, and Modified Mayo Wrist score (MMWS). Results In both the groups improvement occurred in Finkelstein test, VAS score, DASH score, and MMWS which were found to be statistically significant at all points of follow-ups when compared to the pre-intervention values. Comparison of scores between the two groups did not show any statistical significance. No complications were reported in PRP group. Statistically significant complications ( p -value = 0.026) like subcutaneous fat atrophy, depigmentation, and temporary increase in pain were seen in eight patients in the corticosteroid group with an overall complication rate of 26.67%. Conclusion Both the modalities are equally effective in the management of DQTSV remittance. PRP is equally effective as corticosteroid in reducing symptoms of first dorsal compartment stenosing tenosynovitis. PRP may have a lower complication profile, however, this benefit should be weighed against the slight increase in cost and time of PRP preparation and injection. Level of Evidence Level 2, prospective comparative study.