Adding Regenerative medicine to your practice.

[drusso]

I do PRP on request. Joints, bursa. Spin blood in office here. No kits.

I wouldn't do it on request. I would only do it when medically indicated.

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[lobelsteve]

Only one spin? or do you double spin?

10 min in lab centrifuge.

 

[lobelsteve]

I wouldn't do it on request. I would only do it when medically indicated.

I don't push it and other than lateral epicondylitis I am not sure it is indicated for anything. Just another treatment to try.

 

[lobelsteve]

Principles and Methods of Preparation of Platelet-Rich Plasma: A Review and Author's Perspective

The utility of platelet-rich plasma (PRP) has spanned various fields of dermatology from chronic ulcer management to trichology and aesthetics, due to its role in wound healing. Though PRP is being used over a long time, there is still confusion over ...

www.ncbi.nlm.nih.gov

Buffy coat method.

 

[MitchLevi]

i drive an F250 diesel......do you know why i do both?

I don't. Please explain.

 

[deleted131481]

I do PRP on request. Joints, bursa. Spin blood in office here. No kits.

Any idea what the patient is charged? Do you get wrvu for the visit?

 

[nvrsumr]

MRI: Right hip superior and anterosuperior labral tear with superior chondral labral separation, high-grade chondromalacia in the superior right acetabulum and focal subcentimeter full-thickness chondral defect in the superior right femoral head

Pre and post fluoro guided PRP injection at site of labral tear on arthrogram. Feels alot better day 1. Will see how he does. Anyone have other treatment suggestions? Patient wants to avoid labral repair surgery. 50 yo athlete. Ortho said candidate for surgery but crutches for a month and 9 month recovery.

 

[Dr. Ice]

MRI: Right hip superior and anterosuperior labral tear with superior chondral labral separation, high-grade chondromalacia in the superior right acetabulum and focal subcentimeter full-thickness chondral defect in the superior right femoral head

Pre and post fluoro guided PRP injection at site of labral tear on arthrogram. Feels alot better day 1. Will see how he does. Anyone have other treatment suggestions? Patient wants to avoid labral repair surgery. 50 yo athlete. Ortho said candidate for surgery but crutches for a month and 9 month recovery.

Doesn’t make much sense to be better after 1 day.

 

[nvrsumr]

Doesn’t make much sense to be better after 1 day.

inflammatory mediators washout? What timeline for improvement do you usually see?

Guy is a straight shooter. Hasn't done any activity yet. Came to me after ortho consult and dealing with issue a few months.

 

[Dr. Ice]

Genuine non placebo functional improvement 6 weeks

 

[nvrsumr]

Specifically with hip labral tears has anyone seen the separation heal with regen med or just pain/functional improvement but still on course for hip replacement in the future?

 

[bedrock]

Specifically with hip labral tears has anyone seen the separation heal with regen med or just pain/functional improvement but still on course for hip replacement in the future?

He will get/need a hip replacement eventually, guaranteed.

PRP can provide some immediate relief before the main effect in a month.

Does he have a significant cam/pincer (impingement)?
His oa in weight bearing portion of hip joint is the main issue here, not the labral tear unless there is true anatomical impingement.

Guy needs to give it full 6 weeks after PRP. If not sufficient then time for stem cells. If insufficient then consider hip RFA.

You said Athlete - is this endurance sports? If cutting sports then a labral has more relevance.

If endurance sports he may have to accept lower level/intensity of participation, while still doing the things he enjoys. Nothing non surgical or surgical, will make him feel 18 again.

 

[nvrsumr]

yes CAM ortho wanted to shave off bone with cadaver labrum reconstruction. Guy is a mountain bike racer. Knows date of injury -was a long race

Wondering if I should tell him to just bite the bullet and get the surgery anyway to try to avoid THA for as long as possible.

I’m not up to date on labral repairs. Any surgeons ever try to just reattach the labrum and call it a day?

 

[Dr. Ice]

Most joint surgeons will not mess with labral tears with minimal OA of the actual joint. They will commonly send to pmr for “spine care” like a bunch of monkey aholes. Have had much of that nonsense to deal with previously.

PRP seems to work well “enough.” Have been following patient and the best results I’ve seen have been 2 years of complete resolution of pain. Just repeated a treatment, will see what the follow up is. Patients are more than happy to repeat treatment (at what I charge comparatively) rather than have some prick surgeon tell them that they can “fix” the labrum but not their pain..cool story bros

 

[lobelsteve]

He will get/need a hip replacement eventually, guaranteed.

PRP can provide some immediate relief before the main effect in a month.

Does he have a significant cam/pincer (impingement)?
His oa in weight bearing portion of hip joint is the main issue here, not the labral tear unless there is true anatomical impingement.

Guy needs to give it full 6 weeks after PRP. If not sufficient then time for stem cells. If insufficient then consider hip RFA.

You said Athlete - is this endurance sports? If cutting sports then a labral has more relevance.

If endurance sports he may have to accept lower level/intensity of participation, while still doing the things he enjoys. Nothing non surgical or surgical, will make him feel 18 again.

Awfully specific advice and guaranteed outcomes. Palantir?

 

[lobelsteve]

Nice article. Case report.

 

[bedrock]

Awfully specific advice and guaranteed outcomes. Palantir?

Research and experience. No guaranteed outcome other than eventual THA for this patient.
As Dr Cox says “all of medicine is just stalling things that will happen anyway”

 

[bedrock]

y

Wondering if I should tell him to just bite the bullet and get the surgery anyway to try to avoid THA for as long as possible.

I’m not up to date on labral repairs. Any surgeons ever try to just reattach the labrum and call it a day?

If he mostly has symptoms with long rides then I’d recommend modifying his bike. Raise the seat, and handlebars to decrease the total hip flexion when pedal stroke is at its peak.

That plus PRP are best first steps.

If he has significant pain just with prolonged weight bearing, then back to my original advice.

If he still has impingement pain after modifying his bike position and biking is very important to him, then he’ll need hip scope to eliminate the impingement.

Lots of mediocre hip arthroscopic procedures out there. If his surgeon is a known hip scope guru, great. If run of the mill sports guy, I’d recommend against. Many orthopedic surgeons are not that good at this.

The North American expert in hip arthroscopy is fairly close to you. Marc Phillipon at Steadman clinic. Takes months to see him and he only does OON billing to commercial insurance, but he is the expert for this continent.

 

[cowboydoc]

If he mostly has symptoms with long rides then I’d recommend modifying his bike. Raise the seat, and handlebars to decrease the total hip flexion when pedal stroke is at its peak.

That plus PRP are best first steps.

If he has significant pain just with prolonged weight bearing, then back to my original advice.

If he still has impingement pain after modifying his bike position and biking is very important to him, then he’ll need hip scope to eliminate the impingement.

Lots of mediocre hip arthroscopic procedures out there. If his surgeon is a known hip scope guru, great. If run of the mill sports guy, I’d recommend against. Many orthopedic surgeons are not that good at this.

The North American expert in hip arthroscopy is fairly close to you. Marc Phillipon at Steadman clinic. Takes months to see him and he only does OON billing to commercial insurance, but he is the expert for this continent.

This is on point. Unfortunately, the guy’s FAI and preferred activity is a tough combo.

Regen will have zero impact on his bony anatomy, which likely led to this in the first place. The requisite downtime for regen or surgery will drive this patient nuts.

Be picky about the surgeon. A regular labral repair involves a loop suture that gets anchored to the acetabulum after a pilot hole. FAI revision is a lot more nuanced. This patient’s bony anatomy is probably the X factor in this case. (Have some plain films to post?)

I dealt with a small labral defect for about a year with no treatment. Only had symptoms with heavy IR and flexion. I had an incident with jumping with some internal rotation and was done for. WB was terrible, mechanical symptoms shut me down. It had turned into 1/4 of the labrum off the bone and bucket handle type mechanism severely limiting motion. Surgeon said it was about as big as was reasonable to expect successful anchor repair. 4 anchors, 6 weeks of crutches. Regular daily activity immediately thereafter. Getting hip flexor to chill out was only issue. Outside of slightly worse ER, which wasn’t great to start, I’m nearly 100% (regarding the hip). Bony anatomy was normal.

 

[nvrsumr]

Any idea when/why they do a simple repair versus cadaver graft? I think cadaver labrum was the part of surgery that spooked him.

As an aside surgeon did his sports fellowship at steadman vail so hopefully competent.

The guy can’t sit or drive comfortably for 3 months. I think he would change his sport of choice if required to and could minimize surgery.

@cowboydoc did you just stop procedures for 6 weeks while on crutches? Bummer

 

[cowboydoc]

Any idea when/why they do a simple repair versus cadaver graft? I think cadaver labrum was the part of surgery that spooked him.

As an aside surgeon did his sports fellowship at steadman vail so hopefully competent.

The guy can’t sit or drive comfortably for 3 months. I think he would change his sport of choice if required to and could minimize surgery.

@cowboydoc did you just stop procedures for 6 weeks while on crutches? Bummer

Not sure on the cadaver option. I can ask next time I see my guy. I did my surgery on Friday before Labor Day, took Tuesday off and was back to full morning of procedures the next Wednesday. Crutched right up to the table. Had to be lazy with stepping away from the c-arm on laterals. Just happened to be the first day I had residents doing an elective with me, so they got scutted a bit. In retrospect, the extra work on my hip flexors during procedures in lead was probably what prolonged recovery.

The surgery and recovery were nothing. 1 oxy evening of and maybe 2-3 tramadol over a few days. I did 4 hours of medicolegal on my couch POD 1. 6 weeks of crutches sucked.

This isn’t supposed be I'm a tough guy story…PRP into my MCL was way worse. That took me out for the weekend. Recognize I did NOT have any bone revision, which changes the scenario considerably.

 

[drusso]

Urology. 2023 Feb 1;S0090-4295(23)00074-2.
doi: 10.1016/j.urology.2023.01.028. Online ahead of print.

Is Platelet Rich Plasma Safe And Effective In Treatment Of Erectile Dysfunction? Randomized Controlled Study​

Hussein Shaher 1, Abdallah Fathi 2, Salah Elbashir 3, Shabieb A Abdelbaki 4, Tarek Soliman 5
Affiliations expand

• PMID: 36736914
• DOI: 10.1016/j.urology.2023.01.028

Abstract​

Objective: To evaluate the safety and efficacy of platelet rich plasma (PRP) injections as a therapeutic modality for mild to moderate erectile dysfunction.
Method: A placebo controlled study of 100 cases with mild to moderate erectile dysfunction. Participants were allocated to 2 groups; the PRP group received 3 injections (3ml each corpus) and the interval between injections was 15 days, while the Placebo (Saline) group received 6ml saline injected intracavernous. Post injection follow up lasted 6 months.
Results: Compared to the placebo group, the PRP group demonstrated a significant improvement at the 1 and 3 months follow up that slightly dropped at the 6 months follow up (p<0.001). The improvement was evident in the duplex parameters, IIEF-EF, SEP Q2 and 3. At 1-month post-treatment follow up (76%) patients in the PRP group had an improved IIEF-EF as they attained a MCID compared to (18%) in the saline group. At the 3-months post-treatment follow up, (72%) patients achieved a MCID in the PRP group versus (16%) in saline group then dropped to (70%) in the PRP group versus (16%) in saline group at the 6-months post-treatment follow up. Patients' overall and intercourse satisfaction levels were higher in the PRP group than the placebo group as demonstrated with the higher IIEF score Q6, 7, 8 and IIEF score Q13, 14 respectively with the maximum improvement reported at the 3-months follow up. No reports of plaque formation, subcutaneous bruising or any other major side effects among participants.
Conclusion: PRP is a safe and promising method for improving of mild to moderate erectile dysfunction.
Keywords: Erectile dysfunction; IIEF-EF; MCID; PRP; SEP.

 

[bedrock]

Urology. 2023 Feb 1;S0090-4295(23)00074-2.
doi: 10.1016/j.urology.2023.01.028. Online ahead of print.

Is Platelet Rich Plasma Safe And Effective In Treatment Of Erectile Dysfunction? Randomized Controlled Study​

Hussein Shaher 1, Abdallah Fathi 2, Salah Elbashir 3, Shabieb A Abdelbaki 4, Tarek Soliman 5
Affiliations expand

• PMID: 36736914
• DOI: 10.1016/j.urology.2023.01.028

Abstract​

Objective: To evaluate the safety and efficacy of platelet rich plasma (PRP) injections as a therapeutic modality for mild to moderate erectile dysfunction.
Method: A placebo controlled study of 100 cases with mild to moderate erectile dysfunction. Participants were allocated to 2 groups; the PRP group received 3 injections (3ml each corpus) and the interval between injections was 15 days, while the Placebo (Saline) group received 6ml saline injected intracavernous. Post injection follow up lasted 6 months.
Results: Compared to the placebo group, the PRP group demonstrated a significant improvement at the 1 and 3 months follow up that slightly dropped at the 6 months follow up (p<0.001). The improvement was evident in the duplex parameters, IIEF-EF, SEP Q2 and 3. At 1-month post-treatment follow up (76%) patients in the PRP group had an improved IIEF-EF as they attained a MCID compared to (18%) in the saline group. At the 3-months post-treatment follow up, (72%) patients achieved a MCID in the PRP group versus (16%) in saline group then dropped to (70%) in the PRP group versus (16%) in saline group at the 6-months post-treatment follow up. Patients' overall and intercourse satisfaction levels were higher in the PRP group than the placebo group as demonstrated with the higher IIEF score Q6, 7, 8 and IIEF score Q13, 14 respectively with the maximum improvement reported at the 3-months follow up. No reports of plaque formation, subcutaneous bruising or any other major side effects among participants.
Conclusion: PRP is a safe and promising method for improving of mild to moderate erectile dysfunction.
Keywords: Erectile dysfunction; IIEF-EF; MCID; PRP; SEP.

I think I’d still choose viagra over needles into my manhood!

 

[oreosandsake]

I think I’d still choose viagra over needles into my manhood!

You should see the shockwave therapy they use to treat ED!

 

[oreosandsake]

Some photos from the Advanced Regenerative Medicine Institute this weekend

 

[lobelsteve]

You should see the shockwave therapy they use to treat ED!

https://onlinelibrary.wiley.com/doi/full/10.2164/jandrol.108.007344

GRAPHIC WARNING: Do not click and scroll unless you want to see actual pics of an RF needle in correct position to relieve premature ejaculation via pulsed RF.

 

[cowboydoc]

I think I’d still choose viagra over needles into my manhood.

Worse yet, who signs up for this study and gets placebo injection in their manhood?

 

[Doctodd]

Urology. 2023 Feb 1;S0090-4295(23)00074-2.
doi: 10.1016/j.urology.2023.01.028. Online ahead of print.

Is Platelet Rich Plasma Safe And Effective In Treatment Of Erectile Dysfunction? Randomized Controlled Study​

Hussein Shaher 1, Abdallah Fathi 2, Salah Elbashir 3, Shabieb A Abdelbaki 4, Tarek Soliman 5
Affiliations expand

• PMID: 36736914
• DOI: 10.1016/j.urology.2023.01.028

Abstract​

Objective: To evaluate the safety and efficacy of platelet rich plasma (PRP) injections as a therapeutic modality for mild to moderate erectile dysfunction.
Method: A placebo controlled study of 100 cases with mild to moderate erectile dysfunction. Participants were allocated to 2 groups; the PRP group received 3 injections (3ml each corpus) and the interval between injections was 15 days, while the Placebo (Saline) group received 6ml saline injected intracavernous. Post injection follow up lasted 6 months.
Results: Compared to the placebo group, the PRP group demonstrated a significant improvement at the 1 and 3 months follow up that slightly dropped at the 6 months follow up (p<0.001). The improvement was evident in the duplex parameters, IIEF-EF, SEP Q2 and 3. At 1-month post-treatment follow up (76%) patients in the PRP group had an improved IIEF-EF as they attained a MCID compared to (18%) in the saline group. At the 3-months post-treatment follow up, (72%) patients achieved a MCID in the PRP group versus (16%) in saline group then dropped to (70%) in the PRP group versus (16%) in saline group at the 6-months post-treatment follow up. Patients' overall and intercourse satisfaction levels were higher in the PRP group than the placebo group as demonstrated with the higher IIEF score Q6, 7, 8 and IIEF score Q13, 14 respectively with the maximum improvement reported at the 3-months follow up. No reports of plaque formation, subcutaneous bruising or any other major side effects among participants.
Conclusion: PRP is a safe and promising method for improving of mild to moderate erectile dysfunction.
Keywords: Erectile dysfunction; IIEF-EF; MCID; PRP; SEP.

Now do the G shot.

 

[Ducttape]

study does look promising for benefit. appropriately blinded. clinically significant change in results. patient satisfaction. no complications, although only 50 per group, they did do power analysis.


they do not propose a mechanism of how it works.


just to be clear, for both groups, it was 6 injections per session, and total of 18 injections.

 

[MitchLevi]

https://onlinelibrary.wiley.com/doi/full/10.2164/jandrol.108.007344

GRAPHIC WARNING: Do not click and scroll unless you want to see actual pics of an RF needle in correct position to relieve premature ejaculation via pulsed RF.

Thanks

 

[bedrock]

just to be clear, for both groups, it was 6 injections per session, and total of 18 injections.

18 😱

 

[clubdeac]

https://onlinelibrary.wiley.com/doi/full/10.2164/jandrol.108.007344

GRAPHIC WARNING: Do not click and scroll unless you want to see actual pics of an RF needle in correct position to relieve premature ejaculation via pulsed RF.

That’s insane. They say no one experienced pain during the procedure. My ass they didn’t

 

[VA Hopeful Dr]

I think I’d still choose viagra over needles into my manhood!

Remember Caverject?

 

[Ducttape]

for the study - base of penis, 1 cm up and midshaft.

both sides.

local topical anesthetic.

was going to make an inappropriate comment about a certain member of the royalty.... but am going to defer and not get banned...

 

[Agast]

Would diagnostic blocks be required before ablating someone’s penis? I feel like it would be difficult to talk someone into laying there twice.

 

[Ducttape]

you should not be amazed at the things guys will go through, if it would produced the desired results.

 

[oreosandsake]

Some photos from the Advanced Regenerative Medicine Institute this weekend

 

[Doctodd]

any new research from Matt Murphy on long term intradiscal data? He was working with Dragoo last i spoke with him.

 

[drusso]

If I were a steroid KOL, I'd be pissed...


Sports Med Open. 2023 Feb 8;9(1):11.
doi: 10.1186/s40798-023-00556-w.

Effects of Platelet-Rich Plasma in Tear Size Reduction in Partial-Thickness Tear of the Supraspinatus Tendon Compared to Corticosteroids Injection​

Thanathep Tanpowpong 1, Marvin Thepsoparn 2, Numphung Numkarunarunrote 3, Thun Itthipanichpong 1, Danaithep Limskul 1, Phark Thanphraisan 4
Affiliations expand

• PMID: 36752928
• DOI: 10.1186/s40798-023-00556-w

Abstract​

Objectives: Corticosteroid (CS) injection is commonly used in partial-thickness rotator cuff tears to decrease pain. However, this could result in unwanted side effects, such as tendon rupture. Alternatively, platelet-rich plasma (PRP) injection is frequently used to treat tendinopathies because it enhances healing. This study aimed to compare the differences in tear size and functional scores between intralesional PRP and subacromial CS injections.

Methods: Patients with symptomatic partial-thickness tears of the supraspinatus tendon who underwent conservative treatment for ≥ 3 months were enrolled. All patients underwent magnetic resonance imaging (MRI) to confirm the diagnosis. Fourteen and 15 patients were randomized to receive intralesional PRP and subacromial CS injections, respectively. Tears were measured in the coronal and sagittal planes. The patients underwent another MRI 6 months after the injection. Tear size was compared between the two MRI results. The American Shoulder and Elbow Surgeons Shoulder score (ASES) and Constant-Murley score (CMS) were also obtained.

Results: The baseline data were similar between the groups. In the coronal plane, PRP and CS showed tear size reductions of 3.39 mm (P = 0.003) and 1.10 mm (P = 0.18), respectively. In the sagittal plane, PRP and CS showed tear size reductions of 2.97 mm (P = 0.001) and 0.76 mm (P = 0.29), respectively. Functional scores improved 6 months after injection in both groups, but PRP showed better functional scores than CS (P = 0.002 for ASES, P = 0.02 for CS).

Conclusion: Intralesional PRP injection can reduce the tear size in partial-thickness tears of the supraspinatus tendon. Subacromial steroid injection did not significantly affect the tear size. While CS improved functional scores compared with baseline, PRP resulted in better improvement 6 months post-injection. Trial registration Thai Clinical Trials Registry, TCTR20210428004. Registered 28 April 2021-retrospectively registered, TCTR20210428004 .

 

[oreosandsake]

any new research from Matt Murphy on long term intradiscal data? He was working with Dragoo last i spoke with him.

Those Ken Pettine studies stopped coming out 1-2 years ago. 3 years was last follow up published I believe. Was not dragoo

 

[lobelsteve]

If I were a steroid KOL, I'd be pissed...


Sports Med Open. 2023 Feb 8;9(1):11.
doi: 10.1186/s40798-023-00556-w.

Effects of Platelet-Rich Plasma in Tear Size Reduction in Partial-Thickness Tear of the Supraspinatus Tendon Compared to Corticosteroids Injection​

Thanathep Tanpowpong 1, Marvin Thepsoparn 2, Numphung Numkarunarunrote 3, Thun Itthipanichpong 1, Danaithep Limskul 1, Phark Thanphraisan 4
Affiliations expand

• PMID: 36752928
• DOI: 10.1186/s40798-023-00556-w

Abstract​

Objectives: Corticosteroid (CS) injection is commonly used in partial-thickness rotator cuff tears to decrease pain. However, this could result in unwanted side effects, such as tendon rupture. Alternatively, platelet-rich plasma (PRP) injection is frequently used to treat tendinopathies because it enhances healing. This study aimed to compare the differences in tear size and functional scores between intralesional PRP and subacromial CS injections.

Methods: Patients with symptomatic partial-thickness tears of the supraspinatus tendon who underwent conservative treatment for ≥ 3 months were enrolled. All patients underwent magnetic resonance imaging (MRI) to confirm the diagnosis. Fourteen and 15 patients were randomized to receive intralesional PRP and subacromial CS injections, respectively. Tears were measured in the coronal and sagittal planes. The patients underwent another MRI 6 months after the injection. Tear size was compared between the two MRI results. The American Shoulder and Elbow Surgeons Shoulder score (ASES) and Constant-Murley score (CMS) were also obtained.

Results: The baseline data were similar between the groups. In the coronal plane, PRP and CS showed tear size reductions of 3.39 mm (P = 0.003) and 1.10 mm (P = 0.18), respectively. In the sagittal plane, PRP and CS showed tear size reductions of 2.97 mm (P = 0.001) and 0.76 mm (P = 0.29), respectively. Functional scores improved 6 months after injection in both groups, but PRP showed better functional scores than CS (P = 0.002 for ASES, P = 0.02 for CS).

Conclusion: Intralesional PRP injection can reduce the tear size in partial-thickness tears of the supraspinatus tendon. Subacromial steroid injection did not significantly affect the tear size. While CS improved functional scores compared with baseline, PRP resulted in better improvement 6 months post-injection. Trial registration Thai Clinical Trials Registry, TCTR20210428004. Registered 28 April 2021-retrospectively registered, TCTR20210428004 .

Looks good. Tendon rupture is not a true risk, but mentioned in the objective. Small sample size, but big effect on tendon healing. Almost 50% of tendon length healed with PRP, and about 10% with steroid. Methods look suspicious.

For the CS group, the patients received triamcinolone acetonide suspension (Kenacort-A suspension, 40 mg/mL) mixed with 4 mL of 1% lidocaine. The solution was prepared using a 5-mL syringe with a 25-gauge needle and was injected into the subacromial bursa of the affected shoulder. This represents the injection commonly performed in practice.

For the PRP group, we used a double-syringe system (Arthrex ACP, Naples, FL, USA) for PRP extraction. Patients in the group had 15 mL of their blood drawn, which was then centrifuged at 1,500 revolutions per minute for 5 min. Once the centrifugation was complete, double-syringe extraction was performed, which resulted in 5 mL of leukocyte-poor (LP) PRP [17]. The freshly prepared LP-PRP was injected into the supraspinatus tendon tear sites using a 25-gauge needle within 5 s after centrifugation.

We know they did not inject within 5 seconds of centrifuge time, unless centrifuge was on top of patient. Likely meant 5 minutes. Injection location says SAB for steroid, but intralesional for PRP. No mention of US for either. Hmm.

15ml of blood yielded 5ml of injectate? That does not sound right. OREO? DRUSSO? Todd? How much do you draw to get 5cc? I need 40cc to get 4cc and that is a simple single centrifuge, no platelet dot double whammy.

 

[MitchLevi]

Looks good. Tendon rupture is not a true risk, but mentioned in the objective. Small sample size, but big effect on tendon healing. Almost 50% of tendon length healed with PRP, and about 10% with steroid. Methods look suspicious.

For the CS group, the patients received triamcinolone acetonide suspension (Kenacort-A suspension, 40 mg/mL) mixed with 4 mL of 1% lidocaine. The solution was prepared using a 5-mL syringe with a 25-gauge needle and was injected into the subacromial bursa of the affected shoulder. This represents the injection commonly performed in practice.

For the PRP group, we used a double-syringe system (Arthrex ACP, Naples, FL, USA) for PRP extraction. Patients in the group had 15 mL of their blood drawn, which was then centrifuged at 1,500 revolutions per minute for 5 min. Once the centrifugation was complete, double-syringe extraction was performed, which resulted in 5 mL of leukocyte-poor (LP) PRP [17]. The freshly prepared LP-PRP was injected into the supraspinatus tendon tear sites using a 25-gauge needle within 5 s after centrifugation.

We know they did not inject within 5 seconds of centrifuge time, unless centrifuge was on top of patient. Likely meant 5 minutes. Injection location says SAB for steroid, but intralesional for PRP. No mention of US for either. Hmm.

15ml of blood yielded 5ml of injectate? That does not sound right. OREO? DRUSSO? Todd? How much do you draw to get 5cc? I need 40cc to get 4cc and that is a simple single centrifuge, no platelet dot double whammy.

Our kits are 54cc blood + 6cc AC to yield about 7cc LP PRP. We double spin.

15cc of blood to get 5cc LR PRP sounds like a blood patch someone laid down on top of a clothes dryer for 5 min.

BTW - I did a LP PRP injection 6w ago on a guy who followed up today. He got 1cc in the AC joint, 2cc supraspinatus, 2cc infraspinatus and 1cc biceps tendon sheath. He has severe AC OA, partial thickness supra and infraspinatus tears and biceps tendinitis.

He is virtually pain free in the shoulder. I gave him Monovisc in the left knee today.

 

[lobelsteve]

Our kits are 54cc blood + 6cc AC to yield about 7cc LP PRP. We double spin.

15cc of blood to get 5cc LR PRP sounds like a blood patch someone laid down on top of a clothes dryer for 5 min.

BTW - I did a LP PRP injection 6w ago on a guy who followed up today. He got 1cc in the AC joint, 2cc supraspinatus, 2cc infraspinatus and 1cc biceps tendon sheath. He has severe AC OA, partial thickness supra and infraspinatus tears and biceps tendinitis.

He is virtually pain free in the shoulder. I gave him Monovisc in the left knee today.

10% yield. Same as me. 33% yield in study seems sketchy.

 

[cowboydoc]

They used the arthrex acp (autologous conditioned plasma). It yields a low concentration of platelets, but the volumes are consistent with that system.

 

[Ducttape]

the results are encouraging but a few concerning points.

- steve makes a good point. they specifically mention use of US with PRP but they make no mention of US with CS. is this an unforced error or deliberate? if there are different techniques then it may be the technique that explains the difference, not the injectate.

- and with that in mind, it appears the PRP went in to the supraspinatus tendon, but the steroid injection went in to the subacromial bursa. why the difference?

- in addition, the injectionist was not blinded. he knows what is being given, and that may alter his performance. i dont think he is a steroid KOL...



- of interest - the supposed decrease in tear size was not correlated with improvements in functional scores, which doesnt make sense to me, if that is what is helping functionally.

Pearson’s correlation was done to see whether there was a correlation between tear size reduction and functional score improvement. There was no correlation between tear size reduction in the coronal plane and the ASES (r = 0.04) and CMS (r = 0.04). The reduction in tear size in the sagittal plane also did not correlate with the ASES (r = 0.19) and CMS (r = 0.14). However, we found that there was a correlation between tear size reduction between the coronal and sagittal plane (r = 0.71, P < 0.001).

- limitations - no placebo control and small sample size.

i know, i sound like a broken record. at least they did make a small attempt to address, and they did discuss. kudos on that.

 

[Doctodd]

Because steroids into tendon=bad

 

[cowboydoc]

Any idea when/why they do a simple repair versus cadaver graft? I think cadaver labrum was the part of surgery that spooked him.

As an aside surgeon did his sports fellowship at steadman vail so hopefully competent.

The guy can’t sit or drive comfortably for 3 months. I think he would change his sport of choice if required to and could minimize surgery.

@cowboydoc did you just stop procedures for 6 weeks while on crutches? Bummer

My guy said he only uses cadaver if the labrum is in really bad shape and he needs to try to close the gap to keep continuity of the IA space. It sounds low yield and like a salvage procedure by the description.

 

[Ducttape]

Because steroids into tendon=bad

most likely, but it does introduce a confounder in to the study.

 

[drusso]

Our kits are 54cc blood + 6cc AC to yield about 7cc LP PRP. We double spin.

15cc of blood to get 5cc LR PRP sounds like a blood patch someone laid down on top of a clothes dryer for 5 min.

BTW - I did a LP PRP injection 6w ago on a guy who followed up today. He got 1cc in the AC joint, 2cc supraspinatus, 2cc infraspinatus and 1cc biceps tendon sheath. He has severe AC OA, partial thickness supra and infraspinatus tears and biceps tendinitis.

He is virtually pain free in the shoulder. I gave him Monovisc in the left knee today.

What you describe above it not unusual, and I call it "Just another day at the office."

 

[MitchLevi]

What you describe above it not unusual, and I call it "Just another day at the office."

#metoo