Ultrasound-guided Platelet-rich Plasma Injection Research Articles

Platelet-Rich Plasma Treatments of Horizontal Meniscal Tears: A Comparative Analysis

Background: Meniscus injuries remain the most common indication for orthopedic surgery. Due to advances in magnetic resonance imaging (MRI), the number of patients diagnosed with meniscus injuries that do not extend into the articular surface has increased. Although treatments of complete meniscal tears are defined, treatment of meniscus injuries that do not extend into the articular surface is not clear yet.Objective: To determine the most optimal way of delivering platelet-rich plasma (PRP) into the knee joint for treatment of meniscus injuries (not extending into the articular surface) so that patients would improve clinically, and it would have also an effect on the meniscus shown on MRI.Materials and methods: We studied treatment results in 87 patients (50 men and 37 women). The patients were divided into 2 groups: group 1 received an ultrasound-guided PRP injection into the posterior horn, and group 2 received a standard intra-articular PRP injection via the superolateral approach. The treatment efficacy was assessed using visual analog scale (VAS), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, Lysholm score, and Knee Society Score (KSS). We also assessed changes on MRI 6 and 12 months after treatment.Results: The comparative analysis demonstrated that based on the findings of scores and MRI the ultrasound-guided intrameniscal PRP injection is more effective.Conclusions: Our results show that the intrameniscal PRP injection is a more effective and safe way to treat such meniscus injuries.

Nanosurgical and Bioengineering Treatment of Human Anterior Cruciate Ligament Tears with Ultrasound-Guided Injection of Modified Platelet-Rich Plasma Using Human Cell Memory Based on Clinical, Ultrasound, MRI, and Nanoscope Analyses: A Double-Blind Randomized Trial.

Background: Anterior cruciate ligament (ACL) tears account for 40% to 50% of all ligamentous knee injuries. Most patients with ACL ruptures undergo surgical treatment. There is currently no objective, well-documented, repeatable, and standardized nonsurgical method for ACL tear treatment. This study aimed to investigate ACL outcomes in patients who underwent a novel nanosurgery and bioengineering treatment (NSBT) for an ACL tear. Methods: This was a double-blind randomized trial including 44 patients with a history of traumatic knee injury and a confirmed ACL tear. The final sample comprised 40 patients who met all the eligibility criteria. The patients were divided into two groups: the treatment group (n = 30) and the control group (n = 10). The treatment group underwent nanosurgery with an ultrasound-guided injection of modified platelet-rich plasma (PRP) using human cell memory (RP-hCM). The control group was treated with an ultrasound-guided PRP injection into the joint capsule. At baseline and post-treatment, all patients underwent both ultrasonography and magnetic resonance imaging (MRI), and the following clinical variables were assessed: the WOMAC score, the Lysholm knee score, the visual analog scale score, and knee instability. In most patients, the clinical outcome was verified using nanoscopy. Results: The median WOMAC, VAS, and LKS scores, as well as knee instability, improved significantly 12 weeks after the procedure in the treatment group (p < 0.001). We found a significantly larger improvement in the assessed parameters in the treatment group compared to the control group (p < 0.001). In the treatment group, all the patients had good and very good clinical outcomes, while 90% of the patients had a normal ACL signal in a follow-up MRI scan. In the control group, a physical examination revealed no changes in knee stability after treatment. Conclusions: This study showed that there is a significant difference in patient experience and the duration of recovery for patients with ACL tears treated with NSBT. The novel nonsurgical method was shown to be repeatable, objective, well documented, standardized, and highly effective.

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.

Ultrasound-guided platelet-rich plasma vs. radiofrequency nerve ablation for refractory plantar fasciitis

Objectives: Plantar fasciitis (PF), which accounts for approximately 80% of heel pain, is a common condition affecting adults' quality of life. There are many different treatment modalities used in the treatment of PF. In this study, we compared the clinical and functional outcomes of patients diagnosed with chronic PF in our clinic who underwent USG-guided PRP (platelet-rich plasma) injection and patients who underwent RFNA (radiofrequency nerve ablation) treatment. Methods: Ultrasound-guided PRP injection or RFNA was performed on 95 patients who were diagnosed with chronic PF and met the inclusion criteria. This group of patients was followed for at least one year (October 2021-October 2023), and the clinical and functional results of the patients were compared. Results: The mean pre-treatment Visual Analog Scale (VAS), Foot Function Index (FFI), and American Orthopaedic Foot and Ankle Society (AOFAS) posterior-ankle scores were similar, and no significant difference was found (P&amp;gt;0.05). A significant improvement was observed in the groups' FFI, VAS, and AFOAS scores after treatment (P&amp;lt;0.05). However, no significant difference was found in treatment modalities (P&amp;gt;0.05). Conclusions: As a result of the study, it was concluded that PRP injection and RFNA are effective treatment methods in patients diagnosed with chronic plantar fasciitis without response to other conservative treatment methods, but these two methods are not superior to each other.

Comparison of efficacy of ultrasound-guided platelet rich plasma injection versus dry needling in lateral epicondylitis-a randomised controlled trial.

To assess whether Ultrasound guideddry needling is adequate for both common extensor tendon tears and tendinosis or whether ultrasound guidedplatelet rich plasma (PRP) has a superior outcome when compared to dry needling when there are tears of the common extensor tendon. This is a single-centre, single-blinded, randomised controlled trial conducted between November 2018 and April 2020. 40 patients diagnosed with lateral epicondylitis based on clinical and sonographic features and having comparable baseline characteristics were randomly assigned to the two study groups (dry needling and PRP). Inclusion criteria were patients aged 20years or more who were symptomatic for at least 3 months with sonographic evidence of lateral epicondylitis. Exclusion criteria were complete tear of common extensor tendon confirmed on ultrasound and presence of other associated diseases like osteoarthritis of shoulder and elbow. There was significant improvement in the visual analogue scale pain score in PRP group compared to the dry needling group at 9 months. However, this difference was not evident at 3 and 6 months follow-up. Mean improvement in common extensor tendon thickness in PRP group (5.1 mm at 3 months and 4.3 mm at 6 months) was slightly better than dry needling (4.4 mm at 3 months and 4.0 mm at 6 months). There was no difference in tear (if present) healing between both groups at 3months. However at 6months follow up, PRP demonstrated significant (mean-2.5) healing in tear compared to dry needling (mean-3.1). Two injections of Ultrasound guidedPRP are more beneficial non operative treatment compared to ultrasound guideddry needling, in lateral epicondylitis.

Ultrasound-guided injection of steroids versus platelet-rich plasma for sacroiliac joint chronic pain management

Background The spectrum of pain and disability from sacroiliac joint dysfunction is extremely variable. The treatment of SIJ pain remains a therapeutic challenge. Intra-articular SIJ infiltrations with local anesthetic and corticosteroids have the most reliable evidence supporting their use. New modalities have been introduced, such as platelet-rich plasma (PRP) injection. Aim This study aimed to assess and compare the efficacy of ultrasound (US) guided intra-articular and peri-articular SIJ injection with steroids (methylprednisolone) versus platelet-rich plasma (PRP) in relieving chronic SIJ pain and to assess the patient’s satisfaction, record any complications and deal with them accordingly. Patients and methods Fifty patients undergoing sacroiliac joint injection for the treatment of SIJ pain were included in the study. All patients have been randomly allocated to one of two groups: Group S received US-guided intra-articular and peri-articular injection of bupivacaine and methylprednisolone. Group P received US-guided intra-articular and peri-articular SIJ injection of bupivacaine and PRP. Results Demographic data showed no statistically significant difference between both groups. The provocative tests, the VAS score, and the MODQ score at preinjection showed no statistically significant difference. At 2 and 4 weeks postinjection, there was a statistically significant difference between the two groups showing higher values in group S than in group P. At six weeks postinjection, provocative tests were recorded in both groups with no significant difference between them. On the other hand, at eight weeks and four months postinjection, there was a statistically significant difference between the two groups showing higher values for group P than group S. The SAPS score was compared between the two groups and showed no statistically significant difference between them in any of the follow-up periods. As for the efficacy between the two groups, no statistically significant difference was noted. Regarding the complications between the two groups, there was no statistically significant difference. Conclusion US-guided PRP and steroid (methylprednisolone) injections into the SIJ are safe and effective modalities for reducing functional disability as well as decreasing low back pain.

Platelets-rich-plasma in management of non operative post cruciate ligament injury.

Posterior cruciate ligament (PCL) injury is a rare ligamentous knee injury which most commonly occurs due to direct trauma; it represents only 0.65% of knee injuries. On the basis of magnetic resonance imaging (MRI), PCL injury is divided into surgical and non-surgical. In the last few years we have witnessed an increasing interest in regenerative medicine. The use of innovative techniques allow the reduction of rehabilitation times in sports injuries. Platelet-Rich-Plasma (PRP) is a plasma-derived which stimulate the tissue repair. The objective of our work is to compare the rehabilitation times in PCL non-operative injuries treated with standard conservative treatment and PCL injuries treated with autologous PRP followed by rehabilitation program. We divided patients into two different groups: Group A formed by patients who underwent a standard conservative rehabilitation program and Group B which included patients treated by ultrasound guided PRP injection and following physiotherapy program. Both groups of patients resumed sports activities; however the rehabilitation times for patients which had undergone treatment with autologous PRP injection were reduced compared to patients who underwent a standard conservative treatment.

Effectiveness and safety of an ultrasound-guided injection of platelet-rich plasma versus sodium hyaluronate in patients with knee osteoarthritis

Purpose: To examine the effectiveness and safety of ultrasound-guided platelet-rich plasma (PRP) injection versus sodium hyaluronate injection in patients with knee osteoarthritis (KOA).Methods: The clinical data of 92 patients treated at the West China Hospital Sichuan University-Ziyang Hospital between May 2020 and December 2021 were retrospectively analyzed. Patients were allocated to PRP group (ultrasound-guided PRP injection) and a hyaluronic acid (HA) group (sodium hyaluronate injection) with each group containing 46 patients. Before and after treatment, the two groups were compared in terms of visual analog scale (VAS) score, Lysholm score, levels of serum inflammatory factors, insulin-like growth factor (IGF)-1, fibroblast growth factor (FGF)-2 and WOMAC score.Results: After treatment, PRP group exhibited significantly lower pain scores and higher function scores than HA group. Furthermore, PRP group exhibited lower levels of inflammation markers, higher levels of growth factors as well as better treatment efficiency and incidence of adverse reactions when compared with HA group (p &lt; 0.05).Conclusion: Ultrasound-guided PRP therapy ameliorates pains and joint functions in KOA patients. The therapeutic effect may be associated with the regulation of cartilage performance and alleviation of inflammatory state. Therefore, PRP injection therapy combined with ultrasound guidance might also have clinical potential for other applications.

Comparison of Clinical Outcomes after Platelet-Rich Plasma and Rotator Cuff Repair in High-Grade Intrasubstance Partial Rotator Cuff Tears.

Platelet-rich plasma injections have been shown to have many useful applications in various musculoskeletal pathologies. Research on the use of PRP for intrasubstance partial-thickness rotator cuff tears is lacking, although these tears have unique properties that may increase the efficacy of platelet-rich plasma injections. Patients with MRI-confirmed high-grade intrasubstance partial-thickness rotator cuff tears, that had failed traditional non-operative treatment, were offered either surgical repair (Group 1) or a single ultrasound-guided platelet-rich plasma injection into the tear site (Group 2). Patients were followed at 2 weeks, 6 weeks, 3 months, and a minimum of 2 years post-injection with ASES scores. A total of 25 patients received platelet-rich plasma injections, compared to 20 patients who had rotator cuff repair for intrasubstance tears in the last 3 years. The mean pre-injection ASES score for the platelet-rich plasma group was 53.2 and this improved to 92.9 at a minimum 2-year follow-up. The average convalescence period following platelet-rich plasma injection was 3.3 months. The average post-operative convalescence period for arthroscopic rotator cuff repair was 4.6 months. Both surgical repair and platelet-rich plasma injection into the tear site are equally effective in the treatment of high-grade intrasubstance partial-thickness rotator cuff tears, while platelet-rich plasma provides significantly shorter recovery time.

Process Optimization and Efficacy Assessment of Standardized PRP for Tendinopathies in Sports Medicine: Retrospective Study of Clinical Files and GMP Manufacturing Records in a Swiss University Hospital.

Platelet-rich plasma (PRP) preparations have recently become widely available in sports medicine, facilitating their use in regenerative therapy for ligament and tendon affections. Quality-oriented regulatory constraints for PRP manufacturing and available clinical experiences have underlined the critical importance of process-based standardization, a pre-requisite for sound and homogeneous clinical efficacy evaluation. This retrospective study (2013-2020) considered the standardized GMP manufacturing and sports medicine-related clinical use of autologous PRP for tendinopathies at the Lausanne University Hospital (Lausanne, Switzerland). This study included 48 patients (18-86 years of age, with a mean age of 43.4 years, and various physical activity levels), and the related PRP manufacturing records indicated a platelet concentration factor most frequently in the range of 2.0-2.5. The clinical follow-up showed that 61% of the patients reported favorable efficacy outcomes (full return to activity, with pain disappearance) following a single ultrasound-guided autologous PRP injection, whereas 36% of the patients required two PRP injections. No significant relationship was found between platelet concentration factor values in PRP preparations and clinical efficacy endpoints of the intervention. The results were in line with published reports on tendinopathy management in sports medicine, wherein the efficacy of low-concentration orthobiologic interventions appears to be unrelated to sport activity levels or to patient age and gender. Overall, this study confirmed the effectiveness of standardized autologous PRP preparations for tendinopathies in sports medicine. The results were discussed in light of the critical importance of protocol standardization for both PRP manufacturing and clinical administration to reduce biological material variability (platelet concentrations) and to enhance the robustness of clinical interventions (comparability of efficacy/patient improvement).

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.

Effectiveness of Ultrasound-Guided Platelet-Rich Plasma Injection in Comparison with Standard Conservative Treatment on Improving Pain and Function Among the Athletes with Partial Tear of Anterior Talofibular Ligament of Ankle: A Randomized Controlled Trial

Background: Ankle sprain is the most common injury in the world of sports and anterior talofibular ligament (ATFL) is most commonly affected. It is often underestimated, mismanaged and often result in delayed treatment, prolonged recovery times and long-term sequela. PRP may have enhancing effect on healing of partial tear of ATFL. Thus, the purpose of this study is to determine the role of PRP on partial tear of ATFL. Methods: A randomized controlled trail was done among athletes with partial tear of ATFL who visited Department of Sports Medicine, RIMS, Imphal during January 2021 – June 2022. Patients with MRI diagnosed partial tear of ATFL (N=48) randomized into PRP injection plus rehabilitation, (n=24) and rehabilitation alone, (n=24) groups. The outcomes were compared using Foot and Ankle Disability Index (FADI) score for function and Visual analogue scale for pain at baseline, 2nd, 6th, 12th and 24th weeks respectively. Results: Baseline characteristics were not statistically significant. There was statistically significant improvement seen in within the group comparison from baseline to 2nd, 6th, 12th and 24th weeks in both FADI and VAS in both the groups. There were statistically significant difference in mean changes of VAS and FADI score between the two groups from baseline to 2nd (p=0.007);(p=0.012), 6th (p=0.018);(p=0.009) and 12th (p=0.004); (p=0.001) follow-ups respectively with PRP group having more improvement however no significant difference at 24th weeks. Conclusion: Ultrasound guided PRP injection along with standard rehabilitation program might be a treatment of choice for partial ATFL tear. Keywords: ATFL tear, PRP, FADI, VAS, USG-guided.

Optimal Injection Volume in Treatment of Tendinopathy

Background: Tendinopathy, a pathology of tendons characterized by inflammation and or degeneration, is a prevalent cause of disease and disability in active and working patients. Within the past decade, orthobiologic injections such as Platelet Rich Plasma (PRP) have become increasingly popular within the musculoskeletal physician’s practice for treatment of chronic tendinopathies. However, there is a lack of standardization of PRP preparation and injection protocols, leading to gaps in our knowledge regarding the optimal administration dosages to maximize treatment efficacy. Purpose: This review aims to compile and evaluate the existing data for PRP injection volumes for various tendinopathies in hopes of contributing to standardization of PRP protocols, with a further goal of minimiz-ing waste of a costly therapeutic. Study Design: Systematic Review Methods: In June 2020, comprehensive electronic database searches were conducted by a medical librarian in Medline via PubMed, EMBASE (embase.com), CINAHL (EbscoHost), CENTRAL and Scopus according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data was extracted from studies meeting inclusion criteria on injection volumes and outcomes and grouped based on anatomic injection location. Results: Twenty-eight studies were identified for inclusion in which ultrasound-guided intra-tendinous PRP injections were administered to patients to treat various tendinopathies. For all tendon locations, the mini-mum volume of injectate reported achieved positive clinical outcomes in patients compared to baseline. Conclusions: Despite its many benefits—tendon healing, pain relief, increased function—PRP can pose a significant financial burden to patients, with patients often having to pay for the full cost out-of-pocket due to lack of insurance coverage. This study provides evidence that PRP can be effective at smaller volumes, minimizing waste and the out-of-pocket cost to the patient. In addition, this study further stresses the impor-tance of protocol standardization. Clinical Relevance: Though more data is needed, it is apparent that the minimum amount of injectate used clinically for various anatomic locations is enough for overall positive outcomes, and therefore can be the recommended dose given. As such, the authors have incorporated the minimum injection volume into their practice using the following volumes: Rotator Cuff-1 mL, Lateral or Medial Epicondyle-1.5 mL, Gluteal or Hamstring-3 mL, Patella-2 mL, Achilles-3 mL. Unfortunately, without more data available in the literature, the authors cannot make stronger recommendations at this time. What is known about the subject: Among intralesional injections for the treatment of tendinopathy, PRP has shown positive results in multiple trials and has made its way into many musculoskeletal physicians’ practice. However, there is a significant lack of standardization in PRP protocols. What this study adds to existing knowledge: While other reviews have highlighted the discrepancies amongst PRP protocols, our review is the first to examine injection volume and its effect on outcomes. We were able to suggest a minimum injectate amount for positive outcomes, either pain relief or improvement in the tendon appearance on imaging.

Assessing the outcomes of Prp and corticosteroid injections for sacroiliac joint pain

Sacroiliac joint pain is a symptom that can affect the life activities of patients in daily life. Invasive methods also occupy an important place in the treatment of this symptom. Our study evaluated the follow-up results of patients injected with Platelet-rich plasma and steroids due to sacroiliac joint pain. Patient files between the years 2018-2022 were evaluated retrospectively. Patients who underwent ultrasound-guided sacroiliac joint injection of platelet-rich plasma and steroids were divided into 2 groups. VAS and The Modified Oswestry Disability Questionnaire scores were evaluated at 1, 3, and 6 months. Eighty-seven patients were included in the study. It was understood that patients in both groups benefited after injection (p&lt;0.001). In the 1st month follow-up, it was concluded that the VAS and the Modified Oswestry Disability Questionnaire scores of the patient group who received steroids were significantly better (p&lt;0.001). In the 3rd month, the VAS (p=0.695) and the Modified Oswestry Disability Questionnaire (p=0.215) scores of both groups were similar in both groups. In the 6th month, the platelet-rich plasma group's results were significantly better (p&lt;0.001). Platelet-rich plasma and steroid injections are safe treatment methods for sacroiliac joint pain. Steroid injections in the short term and platelet-rich plasma injections in the long term are more effective.

Comparison of Ultrasound-Guided Steroid and Platelet-Rich Plasma (PRP) Injection in Patients with Carpal Tunnel Syndrome

Objective: Imaging-guided injection treatments can yield effective results in patients with mild-to-moderate carpal tunnel syndrome (CTS) resistant to conservative methods. Methods: Patients who presented with typical median nerve entrapment findings for at least 3 months, were diagnosed with mild-moderate CTS electrophysiologically, and underwent ultrasound-guided steroid and PRP injection were included in the study. Visual analog scale (VAS) scores, Boston Carpal Tunnel Questionnaire (Functional status scale (FSS) and Symptom severity scale (SSS) parameters) scores were recorded in the pre-procedure, 1st month and 6th month controls of the patients. Sonographically, median nerve cross-sectional area (CSA) measurements were recorded at pre-procedure and post-procedure 1st and 6th month controls. Results: In 27 patients (21 women, 6 men), 40 median nerve injections (9 patients right, 5 patients left, 13 patients bilateral) were evaluated. In all patients, CSA, VAS, FSS, and SSS scores were significantly lower at 1 month and 6 months after the procedure than before the procedure. (p=0.000, p=0.000, p=0.000, P=0.000, respectively). While the VAS scores were found to be significantly lower in the steroid group than in the PRP group at 1 month (p=0.04), there was no significant difference between the two groups in terms of CSA, FSS, and SSS scores (p=0.1, p=0.5, p=0.8, respectively). At 6 months, CSA, VAS, FSS, and SSS scores were significantly lower in the PRP group compared to the steroid group (p=0.000, p=0.000, p=0.000, p=0.000 respectively). Conclusion: In mild-to-moderate carpal tunnel syndrome, steroid injections applied under ultrasonography guidance of the median nerve are effective for a short time, and PRP injections are a superior and safe option to steroids for long-term efficacy.

Efficacy of ultrasound-guided platelet-rich plasma injection in partial rotator cuff ruptures

Efficacy of ultrasound-guided platelet-rich plasma injection in partial rotator cuff ruptures

Observation on the effect of platelet-rich plasma combined with drugs in the treatment of herpes zoster neuralgia

Purpose To observe the effect of ultrasound-guided platelet-rich plasma (PRP) injection in the treatment of herpes zoster neuralgia (HZN). Methods Eighty patients with HZN were randomly divided into observation group and control group, with 40 cases in each group. The observation group was treated with ultrasound-guided PRP injection of target nerves combined with drugs. The control group was treated with drugs alone. The pain scores of before treatment (T0), and 1 week (T1), 1 month (T2), 3 months (T3) and 6 months (T4) after treatment were recorded with Numerical Rating Scale (NRS). The sleep quality of patients was assessed with the Athens Insomnia Scale, and the dosage used at each time point, skin lesions, adverse reactions, and the occurrence of postherpetic neuralgia (PHN) were recorded. Results The NRS score of the two groups after treatment showed a downward trend. Compared with T0 at each time point, the difference was statistically significant (p < 0.05). And the NRS score of the observation group was lower than control group (p < 0.05). The sleep quality of the observation group was better. The dosage of the observation group was less, and the time of herpes dry-up, scab crusting and shedding in the observation group was significantly shorter (p < 0.05). The incidence of dizziness, lethargy, ataxia and PHN in the observation group was significantly reduced (p < 0.05). Conclusion Compared with traditional drug treatment alone, the ultrasound-guided PRP injection has the advantages of better analgesia and fewer side effects, which provides a new idea for the treatment of HZN.

Ultrasound-guided injection of platelet-rich plasma for tendinopathies: a systematic review and meta-analysis.

In this systematic review and meta-analysis, we evaluated ultrasound (US)-guided injections of platelet-rich plasma (PRP) as conservative treatment of tendinopathies. We searched MEDLINE, EMBASE, SCOPUS, OVID, and the Cochrane Library to identify randomized controlled trials (RCT) on the use of US-guided PRP for tendinopathies. We found 33 RCT (2,025 subjects) that met our inclusion criteria: 8 in lateral epicondylitis, 5 in plantar fasciitis, 5 in Achilles tendinopathy, 7 in rotator cuff tendinopathy, 3 in patellar tendinopathy and 5 in carpal tunnel syndrome. PRP, given as a single injection (20 trials) or multiple injections (13 trials), was compared to US-guided injection of steroids, saline, autologous whole blood, local anesthetic, dry needling, prolotherapy, bone marrow mesenchymal stem cells, or with non-injective interventions. The outcomes more commonly reported included pain and functional measures, subgrouped as in the short-term (<3 months from the intervention), medium-term (3 to 6 months) or long-term (≥12 months). No clear between-group differences in these outcomes were observed in patients with lateral epicondylitis, plantar fasciitis, or Achilles, rotator cuff or patellar tendinopathy. In patients with carpal tunnel syndrome, visual analog scale scores for pain at 3 and 6 months and Boston Carpal Tunnel Questionnaire severity scores at 1, 3 and 6 months were significantly lower in PRP recipients than in controls. The certainty of evidence of all these comparisons was graded as low or very low due to risk of bias, imprecision and/or inconsistency. Pain at the injection site was more common among PRP recipients than among controls receiving other US-guided injections. In patients with tendinopathies, a trend towards pain reduction and functional improvement from baseline was observed after US-guided PRP injection, but in the majority of the comparisons, the effect size was comparable to that observed in control groups.

Immunophenotypic characteristics of the fibrous component of the blood-testis barrier when using cell therapy for azoospermia treatment

Objective. Immunohistochemistry testicular tissue collagens evaluation in the treatment of azoospermia with platelet-rich plasma (PRP) and extracorporeal shock wave therapy (ESWT).Materials and methods. We used biopsy material of testicular fragments from 14 patients with an established diagnosis of secretory azoospermia before and after the use of PRP plus ESWT (patent granted RU2738543 from 14.12.2020). The mean age was 33.07 ± 4.64 (28–43 years), the mean duration of the disease – 4,1 ± 2,26 years (1–9 years). All participants received 2 therapy sessions per week during 6 weeks. 1st session included ultrasound-guided PRP injections into testicles and spermatic cords, finally PRP was activated with ESWT (Dornier Aries), 2nd session included ESWT per testicles and epididymis. Immunohistochemistry analysis with antibodies to collagen types I, III and IV of patient’s biopsies with azoospermia were completed on 90 days before treatment and 180 days from last PRP-injection.Results. Before PRP and ESWT therapy: type I collagen was 22.9 ± 4.2 % (p &lt;0.05), type III collagen – 7.3 ± 2.2 % (p &lt;0.05), type IV collagen – 21.4 ± 1.5 % (p &lt;0.05); after combined therapy: type I collagen – 27.3 ± 5.7 % (p &lt;0.05), type III collagen – 7.2 ± 1.5 % (p &lt;0.05), type IV collagen – 32.2 ± 2.6 % (p &lt;0.05).Conclusion. The production of biologically active substances against the background of PRP and ESWT therapy stimulates the collagen various types synthesis, which promotes to the restoration of the fibrous component of the blood-testicular barrier and improves spermatogenesis.

Comparison of single platelet-rich plasma injection with hyaluronic acid injection for partial-thickness rotator cuff tears.

Partial-thickness rotator cuff tears (PTRCTs) is not uncommon, and various nonsurgical injection therapy for PTRCTs emerged. Platelet-rich plasma (PRP) and hyaluronic acid (HA) injection were proposed for treating PTRCTs; however, the relation of dose among injectates was still lacking. This was a prospective, nonrandomized, comparative study. The aim of the study was to compare the effects of ultrasound-guided single PRP injection with three doses of HA injection, combination of postinjection rehabilitation, for treating PTRCTs. Subjects received either ultrasound-guided PRP injection and rehabilitation exercise, or ultrasound-guided subacromial HA injection and rehabilitation exercise. Shoulder Pain and Disability Index (SPADI), range of motion (ROM), pain visual analog scale (VAS), and Constant-Murley Shoulder Score (CMSS) were recorded before injection, and at 1 and 3 months after injection. Forty-eight patients were enrolled. They received either ultrasound-guided single PRP (n = 24) intralesional and peritendinous injection or three doses of HA (n = 24) subacromial injection plus rehabilitation exercise. In the PRP group, SPADI scores, VAS scores, CMSS significantly improved at 1-month and 3-month follow up; flexion and abduction ROM significantly increased at 3-month follow up. In the HA group, SPADI scores, VAS during overhead activities, VAS night pain, and CMSS significantly improved in the first and third months; flexion and active abduction ROM significantly increased in the third month. The PRP group revealed significantly better passive abduction ROM and CMSS at third month than HA group. Ultrasound-guided single PRP injection exhibited comparable benefit to three doses of HA injection in patients with PTRCTs short-termly, with an extended effect regarding passive shoulder abduction ROM and CMSS.