Use Of Platelet-rich Plasma Injections Research Articles

Platelet-Rich Plasma for Knee and Hip Osteoarthritis Pain: A Scoping Review.

Platelet-rich plasma (PRP) is an emerging biological intervention for osteoarthritis (OA), yet the outcomes remain uncertain. The purpose of this study was to review current literature regarding the use of PRP for knee and hip OA. Recent systematic reviews have found significant clinical improvements in outcomes after the administration of PRP compared to hyaluronic acid (HA) in patients with knee OA. One of these reviews included bone marrow aspirate concentrate (BMAC) as a comparison group and found no significant differences in outcomes between PRP and BMAC. Currently, the literature is lacking on whether leukocyte-rich or leukocyte-poor PRP is superior in patients with knee OA. The literature on PRP for hip OA has not provided consistent results as it has for the knee. Two recent systematic reviews evaluated RCTs for patients undergoing treatment with either PRP or HA for hip OA and found no significant differences in clinical outcomes between groups at final follow-up. Current literature regarding the association between OA grade and PRP efficacy has found varying results. The use of PRP injections in the treatment of knee OA appears to be favorable, resulting in clinically comparable or superior outcomes compared to other injection treatments. However, the clinical efficacy of PRP injections in hip OA is far less consistent. Evidence is lacking to suggest that the presence of leukocytes significantly influences clinical outcomes. Further randomized controlled trials on larger cohorts, with longer follow-up, and with comparable formulations are required before recommendations can be made regarding use of PRP for hip OA, the effect of leukocyte concentration, and clinical efficacy based on OA grade.

Does the Combination of Platelet-rich Plasma and Supervised Exercise Yield Better Pain Relief and Enhanced Function in Knee Osteoarthritis? A Randomized Controlled Trial.

Knee osteoarthritis is a leading cause of disability with substantial healthcare costs, and efficient nonsurgical treatment methods are still needed. Platelet-rich plasma (PRP) injections and exercise therapy are used frequently in clinical practice. Whether PRP or PRP combined with exercise is more effective than exercise alone is unclear. (1) Which treatment relieves knee osteoarthritis pain better: PRP alone, exercise, or PRP combined with exercise? (2) Does PRP alone, exercise, or PRP combined with exercise yield better results in terms of the WOMAC score, performance on the 40-m fast-paced walk test and stair climbing test, and the SF-12 health-related quality of life score? In this randomized, controlled, three-arm clinical trial, we recruited patients with mild-to-moderate (Kellgren-Lawrence Grade II or III) knee osteoarthritis with a minimum of 3 points on the 11-point numeric rating scale for pain. During the study period, 157 patients with a diagnosis of knee osteoarthritis were screened and 84 eligible volunteers were enrolled in the study. Patients were randomly allocated (1:1:1) into either the exercise group (28), PRP group (28), or PRP + exercise group (28). Follow-up proportions were similar between the groups (exercise: 89% [25], PRP: 86% [24], PRP + exercise: 89% [25]; p = 0.79). All patients were analyzed in an intention-to-treat manner. There were no between-group differences in age, gender, arthritis severity, and baseline clinical scores (pain, WOMAC, functional performance tests, and health-related quality of life). The exercise group underwent a 6-week structured program consisting of 12 supervised individual sessions focused on strengthening and functional exercises. Meanwhile, the PRP group received three weekly injections of fresh, leukocyte-poor PRP. The PRP + exercise group received a combined treatment with both interventions. The primary outcome was knee pain over 24 weeks, measured on an 11-point numeric rating scale for pain (ranging from 0 to 10, where 0 represents no pain and 10 represents the worst pain, with a minimum clinically important difference [MCID] of 2). The secondary outcome measures included the WOMAC index (ranging from 0 to 100, with lower scores indicating a lower level of disability and an MCID of 12), the durations of the 40-meter fast-paced walk test and stair climbing test, and the SF-12 health-related quality of life score. For the a priori sample size calculation, we used the numeric rating scale score for pain at 24 weeks as the primary outcome variable. The MCID for the numeric rating scale was deemed to be 2 points, with an estimated standard deviation of 2.4. Based on sample size calculations, a sample of 24 patients per group would provide 80% power to detect an effect of this size between the groups at the significance level of p = 0.05. We found no clinically important differences in improvements in pain-defined as ≥ 2 points of 10-at 24 weeks when comparing exercise alone to PRP alone to PRP + exercise (1.9 ± 0.7 versus 3.8 ± 1.8 versus 1.4 ± 0.6; mean difference between PRP + exercise group and exercise group -0.5 [95% confidence interval -1.2 to 0.4]; p = 0.69). Likewise, we found no differences in WOMAC scores at 24 weeks of follow-up when comparing exercise alone to PRP alone to PRP + exercise (10 ± 9 versus 26 ± 20 versus 7 ± 6; mean difference between PRP + exercise group and exercise group -3 [95% CI -12 to -5]; p = 0.97). There were no differences in any of the other secondary outcome metrics among the PRP + exercise and exercise groups. PRP did not improve pain at 24 weeks of follow-up in patients with mild-to-moderate knee osteoarthritis compared with exercise alone. Moreover, exercise alone was clinically superior to PRP alone, considering function and the physical component of health-related quality of life. Despite the additional costs and endeavors related to PRP products, the combination of PRP and exercise did not differ from exercise alone. The results of this randomized controlled trial do not support the use of PRP injections in the treatment of patients diagnosed with mild-to-moderate knee osteoarthritis. Consequently, exercise alone is the recommended treatment for reducing pain and enhancing function throughout this timeframe. Level I, therapeutic study.

The use of platelet-rich plasma injections in the treatment of meniscal injuries - review of the literature

Introduction: In the knee joint are two menisci, which are fibrocartilaginous structures. The tears of the meniscus are one of the most common injuries within knee. Arthroscopy with suturing of torn or menisectomy are the most popular methods of treatment, however in long term observation menisectomy often results in osteoarthritis 10-20 years after surgery. For this reason, less invasive treatment methods are being sought, such as platelet-rich plasma injections. Platelet-rich plasma has many growth factors, which stimulates healing. Objective: The aim of this study is to review latest the literature on the use of platelet-rich plasma injections in the patients with meniscus tears. Material and methods: A literature review was conducted on databases such as PubMed and Google Scholar using the terms: ”meniscus”, “meniscus tear”, “platelet-rich plasma”, “platelet-rich plasma injections”, “meniscus injuries treatment’. Conclusions: The injuries of meniscus are very common, and often must be treated by arthroscopy. Platelet-rich plasma has a positive impact on tissue healing. Platelet-rich plasma injuries in the patients with meniscal tears repair lead to improve healing rates compare with patients without PRP injections, but there is no guidelines and further studies are necessary.

IMPACT OF PLATELET-RICH PLASMA ON INJURIED NASAL MUCOSA IN CHRONIC ATROPHIC RHINITIS

Relevance. The mucous membrane of the nasal cavity is a natural biological barrier that protects the upper respiratory tract from infection. Chronic atrophic rhinitis is characterized by a triad of symptoms and signs, which include progressive atrophy of the nasal mucosa, the formation of crusts and a characteristic unpleasant odor. A promising tool for the pathogenetic therapy of chronic atrophic rhinitis can include the use of platelet-rich plasma injections (PRP therapy).
 The purpose of this study is to investigate the effect of platelet-rich plasma on the content of markers of oxidative damage to biological polymers, the concentration of hydrogen sulfide, and the intensity of collagenolysis in the nasal mucosa under chronic atrophic rhinitis.
 Materials and methods. The study involved 68 patients, categorized into control (n=20) and experimental (n=48) groups. Within the experimental group, patients were randomly assigned to two subgroups: the standard therapy group (n=29) received conventional treatment as per protocols for 28 days, and the PRP therapy group (n=19) received PRP injections alongside standard therapy for chronic atrophic rhinitis over the same duration. The content of free L-oxyproline, the concentration of malondialdehyde, the concentration of hydrogen sulfide (H2S), and the content of oxidatively modified proteins were studied in the nasal mucosa.
 Results. PRP therapy included to the standard treatment for chronic atrophic rhinitis resulted in a significant 42.67% decrease in malondialdehyde content in the nasal mucosa compared to pre-treatment values. The presence of oxidatively modified proteins post-treatment, following the standard therapeutic regimen with the addition of PRP therapy, decreased by 39.25% compared to pre-treatment levels. The concentration of free L-oxyproline in the nasal mucosa, under standard treatment combined with PRP therapy, exhibited a reduction of 38.28% compared to pre-treatment values. Furthermore, the content of hydrogen sulfide (H2S) in the nasal mucosa decreased by 82.27% compared to pre-treatment levels.
 Conclusions. The integration of PRP therapy with standard treatment for chronic atrophic rhinitis enhances treatment efficacy by mitigating oxidative damage to lipids and proteins, reducing collagen breakdown, and limiting the accumulation of H2S in the nasal mucosa.

Current Review of Regenerative Medicine Therapies for Spine-Related Pain.

Persistent spinal pain syndromes are pervasive and lead to functional impairment, increased healthcare utilization, potential disability, and high societal costs. Spinal (cervical, thoracic, lumbar, and sacroiliac joint) pain includes mechanical, degenerative, inflammatory, oncologic, and infectious etiologies. Regenerative medicine is a novel biotechnology targeting mechanical, degenerative, and inflammatory conditions believed to cause pain. Preparations including platelet-rich plasma, mesenchymal stem cells (adipose tissue and bone marrow aspirate concentrates), and growth factors are derived from an autologous donor. The goal of intervention through guided injection of the regenerative media is to reduce inflammation and reverse the degenerative cascade in hopes of restoring normal cellular composition (physiologic homeostasis) and anatomical function to improve pain and function. The authors review limited research supporting the use of platelet-rich plasma injections for facet joint arthropathy and sacroiliac joint pain compared to traditional steroid treatments, as well as the use of platelet rich plasma or mesenchymal stem cells for lumbar discogenic and radicular pain. Current evidence to support regenerative medicine for spine-related pain is limited. Although several studies demonstrated a reduction in pain, many of these studies had a small number of participants and were case series or prospective trials. Regenerative medicine treatments lack evidence for the treatment of spine-related pain. Large randomized controlled trials are needed with consistent study protocols to make further recommendations.

Treatment of Knee Synovitis from Psoriatic Arthritis with Platelet Rich Plasma Injection

Psoriatic arthritis has been known to cause many inflammatory clinical features, including synovitis. In the past, synovitis has been primarily treated with NSAIDs, corticosteroid injections, and synovectomy when needed. This report outlines a 49-year-old female with synovitis caused by psoriatic arthritis who did not respond to conventional treatment options and was apprehensive to surgery. She was offered a platelet rich plasma (PRP) injection as alternative therapy to a synovectomy. This case explores the use of PRP injections as a potential treatment modality for patients with synovitis caused by psoriatic arthritis. This patient was able to show improvement in her symptoms after the use of the platelet rich plasma injection.

P-608 Intra-ovarian platelet-rich plasma administration plus successive accumulated embryo transfer could be a promising strategy for poor ovarian response management: a retrospective cohort study

Abstract Study question Does intra-ovarian injection of platelet-rich plasma (PRP) plus successive accumulated embryo transfer improve the outcome of Patients with Poor Ovarian Response (POR)? Summary answer Intra-ovarian injection of PRP plus successive embryo accumulation following mild stimulation and accumulated embryo transfer appears to be a optimal strategy for POR management. What is known already The treatment of poor responders is a challenge for both patients and clinicians. Various protocols have been adopted in attempts to increase the pregnancy rates in patients with POR; however, the outcomes of these strategies are disappointing. Alternatives are needed. A handful of clinical datas have reported promising results of the use of PRP injections into the ovary. In addition, some clinical evidence proved that embryo accumulation following mild stimulation appears to be an optimal strategy for POR management. However, limited knowledge is available on the effect of the combination of intra-ovarian injection of PRP and accumulated embryo transfer strategy. Study design, size, duration This single-center retrospective study has been performed from May 2021 to May 2022. Using the POSEIDON criteria, 13 group 3 and 36 group 4 POR women undergone intra-ovarian PRP injection combined with accumulation of embryos through 3 successive mild stimulation IVF (ICSI) cycles before transfer. Participants/materials, setting, methods POR Women (AMH<1.2ng/ml) who have undergone intra-ovarian PRP injection and followed by accumulation of embryos through 3 successive mild stimulation IVF (ICSI) cycles before transfer were eligible. According to the POSEIDON criteria, 49 women were included. The primary outcomes were Clinical pregnancy and cancelled cycles. The helpful variables (LH, FSH, AMH, estradiol and AFC) and embryology outcomes of IVF (ICSI) cycles were also collected. Main results and the role of chance The mean age of all participants was 37.67±4.15 years and their mean body mass index was 21.52±2.80 kg/m2. Autologous intraovarian PRP therapy significantly increased AMH levels (0.41±0.05ng/mL vs 0.65±0.13ng/mL, P = 0.035), AFC (2.02±0.19 vs 2.94±0.21, P = 0.0013) and decreased FSH (14.57±1.14 IU/L vs 11.42±0.81IU/L, P = 0.03). Autologous intraovarian PRP therapy accompanied with 3 successive cumulated cycles, significantly increased No. of accumulated embryos (0.46±0.08 vs 1.61±0.17, P < 0.0001) and blastocysts (0.04±0.03 vs 0.92±0.14, P < 0.0001). Also, intra-ovarian injection of PRP plus successive embryo accumulation strategy significantly reduced the rate of cancelled cycle (57.13% (28/49) vs 10.2% (5/49), P < 0.0001). Following this stategy, of 44 cases with accumulated embryos/blastocysts transfer, 20 (45.45%) got clinical pregnant. Limitations, reasons for caution The study was small samples and retrospective, without randomization. In addition, the ongoing pregnancy or live birth may reflect the effect much better. Wider implications of the findings Intra-ovarian injection of PRP plus successive embryo accumulation strategy significantly reduced the risk of cancelled cycle in POR; the clinical pregnant rate is about 45%. It could be the optimal strategy for POR management. Further studies are needed to verify these conclusions and the exact mechanisms of PRP. Trial registration number not applicable

Analgesic efficacy and functional outcome in refractory cases of plantar fasciitis treated with platelet-rich plasma: randomized comparative study with corticosteroids injection

ABSTRACT Background Steroid injection is a widespread treatment for plantar fasciitis but seems to be useful to a lesser extent, Platelet-rich Plasma (PRP) injections into the plantar fascia start the healing process required to stop the degeneration of the plantar fascia at its root. Aim of the study To compare analgesic efficacy, functional outcome, degree of satisfaction and improvement of fascial thickness and echogenicity after platelet-rich plasma injection versus corticosteroids injection in refractory cases of plantar fasciitis. Patients & method 60 patients with refractory plantar fasciitis who were resistant to conservative treatment were randomized to receive either PRP or steroid injection. All patients were assessed with the American Orthopaedic Foot and Ankle Society (AOFAS) score, Visual Analogue Score (VAS) for pain, the Roles-Maudsley (RM) Score and plantar fascia thickness and echogenicity. Data were collected prospectively, pre-treatment, at 3, 6, 12 week, and 6 months post-injection. Results There was significant improvement in both groups as regards the clinical outcome measures involving (VAS & AOFAS) and radiological outcome measures including (thickness and echogenicity) in all post-injection times. However, steroid group showed early improvement (at 3rd week post-injection) with short duration while PRP group showed improvement at 12 weeks post-injection till the end of the study. Conclusion The use of PRP injection is safer with better analgesia and functional outcome than steroid therapy for treating chronic plantar fasciitis.

Update on the Use of Platelet-Rich Plasma Injections in the Management of Musculoskeletal Injuries: A Systematic Review of Studies From 2014 to 2021.

There has been expanding use of platelet-rich plasma (PRP) in the management of musculoskeletal soft tissue injuries. To determine if there are any recent studies that show any clear benefits regarding the use of PRP in the management of soft tissue injuries. Systematic review. This review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The EMBASE, MEDLINE, PubMed, and Cochrane Bone, Joint and Muscle Group Specialised Register databases were queried for randomized controlled trials comparing PRP with a non-PRP/placebo in participants >18 years of age with musculoskeletal soft tissue injuries. Exclusion criteria were non-soft tissue injuries and research published in journals with an impact factor <3.5. The main outcome measure analyzed across all injury types was the effect of PRP injections on pain and function. Of the 853 studies initially screened, 32 were included in this review. There were 13 studies that investigated the effects of PRP on the management of rotator cuff injuries; 7 studies that investigated PRP in conjunction with arthroscopy found no significant difference between PRP groups and controls, while 5 of 6 studies that investigated nonsurgical management showed positive results for PRP. Eight studies investigated various tendinopathies; of these, 2 studies demonstrated positive results for PRP in Achilles and gluteal tendinopathy management. Six studies examined PRP in acute soft tissue injuries, with 2 of these reporting significant improvements in recovery time for hamstring injuries and 1 study showing positive results for ankle ligament injuries. Two studies looked at acute rupture of soft tissues and found no benefit to PRP use. Two studies investigated PRP injections for chronic plantar fasciitis, and both reported positive results in pain and function with PRP. Finally, 1 study evaluated the effects of PRP on meniscal injuries and reported significant improvement in the healing rate and a decreased need for surgical repair. Currently, there is no research strongly advocating the use of PRP compared with traditional management strategies (rest, ice, corticosteroid injection, rehabilitation program). No long-term physiological benefits were reported to justify the invasive and costly technique of obtaining, producing, and implementing PRP.

Platelet-Rich Plasma for Intra-articular Injections: Preclinical and Clinical Evidence.

The use of platelet-rich plasma (PRP) has been supported by encouraging data from in vitro and preclinical in vivo studies, both in terms of safety and efficacy. This led to the wide use of PRP injections in the clinical practice, with promising results especially as a minimally invasive treatment for cartilage degeneration and osteoarthritis (OA). While many controversies remain on the best PRP formulation, the overall available clinical studies support the benefits of PRP, with functional improvement and reduction of pain-related symptoms up to 12months, especially in young patients and early OA stages.

Assessment of clinical outcome of platelet rich plasma (PRP) injection in progression of mild to moderate osteoarthritis patients, a retrospective study

Background and Objectives: Global reports (2020) state that an annual 86.7 million people (age >20 years) are diagnosed with incident knee Osteoarthritis. Various therapies and medications have been given to treat this condition and one such upcoming therapy is the use of Platelet-rich plasma. In spite of the promising outcomes, some experts in the field are yet skeptical about the use of Platelet-rich plasma therapy to treat osteoarthritis. In this study, the investigators attempt to measure the clinical outcome of platelet-rich plasma therapy in patients with progression of mild to moderate osteoarthritis. Methods: Analysis of 102 patient records was carried out from the years 2016-2020 to assess the clinical outcome of the intra-articular Platelet Rich Plasma (PRP) injection in the progression of mild to moderate osteoarthritis patients from the period of pre-injection to 12 months post-injection. Assessment tools such as the VAS and the WOMAC score were used. IBM SPSS software version 1.0 was used for the statistical data analysis. Results: Medical records analyzed of the patients showed a gradual decrease in pain, observed over a period of 12 months post-injection (as assessed by the VAS and WOMAC score). Significant reduction in swelling (Friedman test: Chi-square = 199.68, P< 0.0001) and tenderness (Friedman test: Chi-square = 199.14, P< 0.0001) was also observed. Conclusion: A significant reduction in pain, swelling, tenderness and improvement in function was observed post 12 months of the injection given. The results are encouraging when compared to pre-injection pain and symptoms, suggesting a positive clinical use of PRP injections for mild to moderate osteoarthritic patients.

Effect of Platelet-Rich Plasma Injections vs Placebo on Ankle Symptoms and Function in Patients With Ankle Osteoarthritis

Approximately 3.4% of adults have ankle (tibiotalar) osteoarthritis and, among younger patients, ankle osteoarthritis is more common than knee and hip osteoarthritis. Few effective nonsurgical interventions exist, but platelet-rich plasma (PRP) injections are widely used, with some evidence of efficacy in knee osteoarthritis. To determine the effect of PRP injections on symptoms and function in patients with ankle osteoarthritis. A multicenter, block-randomized, double-blinded, placebo-controlled clinical trial performed at 6 sites in the Netherlands that included 100 patients with pain greater than 40 on a visual analog scale (range, 0-100) and tibiotalar joint space narrowing. Enrollment began on August 24, 2018, and follow-up was completed on December 3, 2020. Patients were randomly assigned (1:1) to receive 2 ultrasonography-guided intra-articular injections of either PRP (n = 48) or placebo (saline; n = 52). The primary outcome was the validated American Orthopaedic Foot and Ankle Society score (range, 0-100; higher scores indicate less pain and better function; minimal clinically important difference, 12 points) over 26 weeks. Among 100 randomized patients (mean age, 56 years; 45 [45%] women), no patients were lost to follow-up for the primary outcome. Compared with baseline values, the mean American Orthopaedic Foot and Ankle Society score improved by 10 points in the PRP group (from 63 to 73 points [95% CI, 6-14]; P < .001) and 11 points in the placebo group (from 64 to 75 points [95% CI, 7-15]; P < .001). The adjusted between-group difference over 26 weeks was -1 ([95% CI, -6 to 3]; P = .56). One serious adverse event was reported in the placebo group, which was unrelated to the intervention; there were 13 other adverse events in the PRP group and 8 in the placebo group. Among patients with ankle osteoarthritis, intra-articular PRP injections, compared with placebo injections, did not significantly improve ankle symptoms and function over 26 weeks. The results of this study do not support the use of PRP injections for ankle osteoarthritis. Netherlands Trial Register: NTR7261.

Platelet-rich Plasma and Its Application in Clinical Trial

Platelet-rich Plasma and Its Application in Clinical Trial

Assessment of the efficacy of platelet-rich plasma injections in the management of severe dry eye

Purpose This study aimed to assess the efficacy of a platelet-rich plasma (PRP) injection into the lacrimal gland in severe dry eye and to compare it with preservative-free artificial tears. Patients and methods This study included a total of 74 eyes of 40 patients divided into two groups. The intervention group received three PRP injections transcutaneously in the region of the lacrimal gland. The control group was treated with preservative-free artificial tears. Results The intervention group showed improvement in all measured parameters, except the Meibomian gland score, with a statistically significant improvement in the Ocular Surface Disease Index (OSDI) score (P&lt;0.001) and the Schirmer test (P=0.011) and less significant improvement in the ocular surface staining score (P=0.076) and tear breakup time (TBUT) (P=0.09). Compared with the control group, the PRP intervention group showed a statistically significant improvement in the OSDI score (P&lt;0.001), the Schirmer test (P=0.005) and the ocular surface staining score (P=0.013) and less significant improvement in TBUT (P=0.2). Conclusion The use of PRP injections is safe and effective, with improvement in the OSDI, Schirmer test, and ocular surface staining and less improvement in TBUT, but it is not effective in improving Meibomian gland function.

Intraovarian injection of platelet-rich plasma in assisted reproduction: too much too soon?

The prospect of ovarian rejuvenation offers the tantalising prospect of treating age-related declines in fertility or in pathological conditions such as premature ovarian failure. The concept of ovarian rejuvenation was invigorated by the indication of the existence of oogonial stem cells (OSCs), which have been shown experimentally to have the ability to differentiate into functional follicles and generate oocytes; however, their clinical potential remains unknown. Furthermore, there is now growing interest in performing ovarian rejuvenation in situ. One proposed approach involves injecting the ovary with platelet rich plasma (PRP). PRP is a component of blood that remains after the in vitro removal of red and white blood cells. It contains blood platelets, tiny anucleate cells of the blood, which are responsible for forming athrombus to prevent bleeding. In addition, PRP contains an array of cytokines and growth factors, as well as a number of small molecules.The utility ofPRP has been investigatedin a range of regenerative medicine approaches and has been shown to induce differentiation of a range of cell types, presumably through the action of cytokines.A handful ofcasereports have described the use of PRP injections into the ovaryin the human, and while these clinical data report promising results, knowledge on the mechanisms and safety of PRP injections into the ovary remain limited.In this article, we summarise some of the physiological detail of platelets and PRP, before reviewing the existing emerging literature in this area. We then propose potential mechanisms by which PRP may be eliciting any effects before reflecting on some considerations for future studies in the area. Importantly, on the basis of our existing knowledge, we suggest that immediate use of PRP in clinical applications is perhaps premature and further fundamental and clinical research on the nature of ovarian insufficiency, as well as the mechanism by which PRP may act on the ovary, is needed to fully understand this promising development.

The Role of Platelet-rich Plasma in Osteoarthritis of Knee-joint

Background: Osteoarthritis is one of the leading causes of disability. Platelet-rich plasma (PRP) is known as autologous conditioned plasma is a concentrate of platelet-rich plasma protein derived from whole blood, centrifuged to remove red blood cells. Now it is used in treating OA. We have very few data regarding this issue. The aim of this study was to assess the role of platelet-rich plasma in osteoarthritis of knee-joint. Materials and methods: This was a prospective observational study which was conducted at the Department of Orthopaedics & Traumatology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh during the period from January 2018 to December 2018. In total 89 patients, diagnosed with grade I and II arthritis were included in this study as the study population. To all the participants three PRP injections were injected in the knees at 4-week interval. Patients were followed up and were assessed for pain and physical activity associated with arthritis using the Western Ontario and McMaster University Arthritis Index (WOMAC) score at the time of induction in the study and at 6 months interval. Results: The mean (±SD) WOMAC score of the participants was 82.94 (±5.12) at the baseline whereas it was found 37.87 (±4.73) at the follow up period after 6 months. After 6 months the mean (±SD) WOMAC score of male participants was found 36.93 (±5.71) and it was found 38.87 (±5.39) among female participants. This difference was statistically significant (P=0.021). Besides this, after 6 months the mean (±SD) WOMAC score of Kellgren–Lawrence grade-1 participants was 37.68 (±5.44) and it was found 40.13 (±5.01) among Kellgren–Lawrence grade-2 participants. This difference was statistically significant (P=0.002). Moreover, after 6 months the mean (±SD) WOMAC score of participants with ≤2 years duration of symptoms was 37.95 (±5.37) and it was found 41.66 (±4.28) among participants with >2 years duration of symptoms. This difference was extremely statistically significant. Conclusions: The proper sequential use of PRP injection for the treatment of osteoarthritis of knee-joint proved to be effective in our study. We recommend its wide use in the treatment of osteoarthritis of knee-joint.

The Cost-Effectiveness of Platelet-Rich Plasma Compared With Hyaluronic Acid Injections for the Treatment of Knee Osteoarthritis

To examine the cost-effectiveness of a series (total of 3 injections) of intra-articular platelet-rich plasma (PRP) injections in comparison to that of hyaluronic acid (HA) viscosupplementation for the treatment of symptomatic knee osteoarthritis. Outcome data regarding the use of PRP or HA injections for the treatment of symptomatic knee osteoarthritis were determined from the highest-quality data (Level I) available in the literature until 2015. Health utility values were then derived from these high-quality data. Costs were determined by examining typical charges for patients undergoing a series of either PRP or HA injections for the treatment of this condition at a large private orthopaedic practice. These health utility values and costs were used to create an expected-value decision analysis model. The results of the model revealed that the cost per quality-adjusted life-year (QALY) of a series of PRP injections was $8,635.23/QALY and that of a series of HA injections was $5,331.75/QALY. A series of PRP injections was associated with a higher initial cost than a series of HA injections (difference, $1,433.67); however, PRP was also more effective (higher utility value) than HA by 0.11 QALYs (0.69 vs 0.58, P= .0062) at 1 year. The incremental cost-effectiveness ratio of the use of PRP injections as opposed to HA was $12,628.15/QALY. Although a series of either PRP ($8,635.23/QALY) or HA ($5,331.75/QALY) injections for the treatment of symptomatic knee osteoarthritis would be considered cost-effective (cost per QALY < $50,000), PRP injections were not more cost-effective than HA injections. However, PRP was significantly more effective at 1 year, and being associated with an incremental cost-effectiveness ratio of $12,628.15/QALY when compared with HA, a series of PRP injections should be considered a reasonable and acceptable alternative to HA injections for the treatment of symptomatic knee osteoarthritis. Level II, economic and decision analysis of Level I studies.

Effects of Platelet-rich Plasma Injections on the Healing of Different Tissues in Athletes: A Systematic Review

Introduction: Sprains, strains, and tendinopathies are some of the most common injuries inathletics and each present their own challenges for sports medicine practitioners. A new form of nonoperative treatment called Platelet-rich plasma (PRP) injections have gained attention and consideration for treating soft tissue injuries. PRP is a preparation of autologous human plasmawith an increased platelet concentration. When injected, the PRP releases larger amounts than normally found in the body of growth factors and cytokines to the injury site. This is theorized to start the natural healing process.Purpose: To analyze the effects of platelet-rich plasma injections in athletes suffering fromligament, tendon, or musculoskeletal injuries through a systematic review of literature.Methods: A search of Pubmed, Cochran Central, Ebscohost, and Medline was conducted with the keywords “platelet-rich plasma injections” followed by “in athletes”. The inclusion criteria consisted of any article analyzing the use of PRP injections for treatment of a sprain, strain, or tendinosis in athletes. The methodology of each article found was critically appraised using the PEDro appraisal scale. The exclusion criteria were articles which used PRP injections for non-athletes, the experiment was conducted on animals, the study compared the injections to another form of treatment, and/or given a score below a five on the PEDro scale.Results: A total of 11 studies were included in the qualitative data synthesis based on theinclusion and exclusion criteria. Three different tissues were researched. Studies analyzing each different type of tissue found the use of platelet-rich plasma injections to be effective inaccelerating the healing process which ultimately decreases the athletes time to return to play. However, some studies also did not find any difference in healing time and pain.Conclusion: The study analyzed new research on the overall effectiveness of platelet-richplasma injections in the athletic population. The available evidence showed an overall positive outcome, but some precautions of accepting the research should be considered. More research should be conducted to solidify these results. Once the research has proven it to be a new form of effective treatment, then it can be utilized by sports medicine teams more frequently to aid in the healing time and decrease time to return to play.

Role of platelet-rich plasma in early osteoarthritis of knee joint: Experience from a tertiary care center in Pakistan.

Osteoarthritis is the most common articular disease. The aim of this study was to observe the outcome after intra-articular platelet-rich plasma (PRP) injection in our patients presenting with knee osteoarthritis. This study was conducted in Dow University of Health Sciences, Karachi, Pakistan, from December 2014 to December 2015. All patients between 35 years and 60 years of age diagnosed with grade I and II arthritis were included in the study. Three PRP injections were injected in the knees at 4-week interval. Patients were followed up in outpatient department (OPD) and were assessed for pain and physical activity associated with arthritis using the Western Ontario and McMaster University Arthritis Index (WOMAC) score at the time of induction in the study and at 6 months interval. Two hundred fourteen patients with the mean age of 55.15 (±6.93) years were studied. Female to male ratio was 3:1. One hundred fifty-five patients were classified as having Kellgren-Lawrence grade 1 osteoarthritis, while 59 were grade 2. One hundred eighty-nine patients had clinical symptoms for less than 2 years and 25 for more than 2 years. Mean WOMAC score before the start of treatment was 83.05, and after 6 months, it was reduced to 38.84 which was statistically significant ( p = 0.000). WOMAC score was improved more in the subgroup with patients having symptoms less than 2 years ( p = 0.005). Three patients developed minor hyperemia which was managed conservatively with activity limitation and ice application, but none of the patient developed gross infection. The sequential use of PRP injection for the treatment of early osteoarthritis proved to be effective in our study.

Where Do Injectable Stem Cell Treatments Apply in Treatment of Muscle, Tendon, and Ligament Injuries?

Treatment options for muscle, tendon, and ligament injuries span a constantly evolving spectrum. For years, treatments focused on symptomatic relief. Closer scrutiny of symptomatic treatment suggests that the provision of transient relief of symptoms may have caused more harm than good. Cortisone injections provide a trade-off of short-term relief for poorer long-term outcomes. When conventional treatment failed, patients have faced limited options including surgery, which has increased risk and limited efficacy. Regenerative injections offer a more robust option for soft tissue disease. Basic science and clinical studies show conflicting results to support the use of platelet-rich plasma injections for soft tissue disorders, and even fewer trials have focused on injectable stem cells with limited findings. Additional studies are needed to determine the potential benefits of this regenerative therapy.