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Not everything that "works" is covered by Medicare and just because something is covered by Medicare doesn't mean it "works."
Why not cover autologous therapies?
Adding Regenerative medicine to your practice.
- Thread starter bronchospasm
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Not everything that "works" is covered by Medicare and just because something is covered by Medicare doesn't mean it "works."
Why not cover autologous therapies?
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i asked about that before.
you said no, because it would severely reduce reimbursements to the point of not making it worth doing.
have you changed your mind about that?
i for one would not mind being able to add regenerative treatments for epicondylitis, rotator cuff and other orthopedic conditions. data still out for spine conditions, but get more data...
you said no, because it would severely reduce reimbursements to the point of not making it worth doing.
have you changed your mind about that?
i for one would not mind being able to add regenerative treatments for epicondylitis, rotator cuff and other orthopedic conditions. data still out for spine conditions, but get more data...
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If the data is there, just do it.
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Am J Sports Med. 2023 May 18;3635465231170394.doi: 10.1177/03635465231170394. Online ahead of print.
Affiliations expand
Hypothesis: LP-PRP would be predominantly anti-inflammatory and have reduced nociceptive pain mediators compared with LR-PRP from the same individual with mild to moderate knee OA.
Study design: Controlled laboratory study.
Methods: A total of 24 unique samples of PRP were prepared in order to assess 48 samples of LR-PRP and LP-PRP taken from 12 patients (6 male and 6 female) with symptomatic knee OA of Kellgren-Lawrence grade 2 to 3. Patients underwent blood collection for LR-PRP and LP-PRP preparation through a double-spin protocol to obtain baseline whole blood, platelet concentration, and white blood cell subtypes. LR-PRP and LP-PRP from the same patient were produced at the same time and underwent a comprehensive panel through Luminex (multicytokine profiling) to assess key mediators of inflammation: interleukin 1 receptor antagonist (IL-1Ra), interleukin 4, 6, 8, and 10 (IL-4, IL-6, IL-8, and IL-10), IL-1β, tissue necrosis factor α (TNF-α), and matrix metalloproteinase 9 (MMP-9). To assess mediators of nociceptive pain, nerve growth factor (NGF) and tartrate resistant acid phosphatase 5 (TRAP5) were also assessed.
Results: LR-PRP from patients with mild to moderate knee OA expressed significantly more IL-1Ra, IL-4, IL-8, and MMP-9 compared with LP-PRP formulations from the same patients. No significant differences were found between LR-PRP and LP-PRP in mediators of nociceptive pain-namely, NGF and TRAP5. Other mediators including TNF-α, IL-1β, IL-6, and IL-10 were also found to have no significant expression differences between LR-PRP and LP-PRP.
Conclusion: LR-PRP expressed significantly more IL-1Ra, IL-4, and IL-8, suggesting that LR-PRP may be more anti-inflammatory than LP-PRP. MMP-9 was expressed in higher concentrations in LR-PRP, suggesting that LR-PRP may be more chondrotoxic than LP-PRP.
Clinical relevance: LR-PRP was found to have a robust expression of anti-inflammatory mediators compared with LP-PRP and may be beneficial to patients with long-term knee OA where chronic low-grade inflammation is present. Mechanistic clinical trials are needed to elucidate the key mediators in both LR-PRP and LP-PRP to assess their effect on long-term progression of knee OA.
Keywords: inflammation; knee; leukocyte; osteoarthritis; pain; platelet-rich plasma.
Leukocyte-Rich Platelet-Rich Plasma Is Predominantly Anti-inflammatory Compared With Leukocyte-Poor Platelet-Rich Plasma in Patients With Mild-Moderate Knee Osteoarthritis: A Prospective, Descriptive Laboratory Study
Prathap Jayaram 1 2, Parker J T Mitchell 3, Theodore B Shybut 3, Bruce J Moseley 3, Brendan Lee 4Affiliations expand
- PMID: 37199381
- DOI: 10.1177/03635465231170394
Abstract
Background: Platelet-rich plasma (PRP) has been used extensively in clinical practice to treat patients with symptomatic knee osteoarthritis (OA). Leukocyte-poor PRP (LP-PRP) has been clinically preferred over leukocyte-rich PRP (LR-PRP); however, it is unclear which cytokine mediators of pain and inflammation are present in LR-PRP and LP-PRP from patients with mild to moderate knee OA in order to rationalize a specific formulation.Hypothesis: LP-PRP would be predominantly anti-inflammatory and have reduced nociceptive pain mediators compared with LR-PRP from the same individual with mild to moderate knee OA.
Study design: Controlled laboratory study.
Methods: A total of 24 unique samples of PRP were prepared in order to assess 48 samples of LR-PRP and LP-PRP taken from 12 patients (6 male and 6 female) with symptomatic knee OA of Kellgren-Lawrence grade 2 to 3. Patients underwent blood collection for LR-PRP and LP-PRP preparation through a double-spin protocol to obtain baseline whole blood, platelet concentration, and white blood cell subtypes. LR-PRP and LP-PRP from the same patient were produced at the same time and underwent a comprehensive panel through Luminex (multicytokine profiling) to assess key mediators of inflammation: interleukin 1 receptor antagonist (IL-1Ra), interleukin 4, 6, 8, and 10 (IL-4, IL-6, IL-8, and IL-10), IL-1β, tissue necrosis factor α (TNF-α), and matrix metalloproteinase 9 (MMP-9). To assess mediators of nociceptive pain, nerve growth factor (NGF) and tartrate resistant acid phosphatase 5 (TRAP5) were also assessed.
Results: LR-PRP from patients with mild to moderate knee OA expressed significantly more IL-1Ra, IL-4, IL-8, and MMP-9 compared with LP-PRP formulations from the same patients. No significant differences were found between LR-PRP and LP-PRP in mediators of nociceptive pain-namely, NGF and TRAP5. Other mediators including TNF-α, IL-1β, IL-6, and IL-10 were also found to have no significant expression differences between LR-PRP and LP-PRP.
Conclusion: LR-PRP expressed significantly more IL-1Ra, IL-4, and IL-8, suggesting that LR-PRP may be more anti-inflammatory than LP-PRP. MMP-9 was expressed in higher concentrations in LR-PRP, suggesting that LR-PRP may be more chondrotoxic than LP-PRP.
Clinical relevance: LR-PRP was found to have a robust expression of anti-inflammatory mediators compared with LP-PRP and may be beneficial to patients with long-term knee OA where chronic low-grade inflammation is present. Mechanistic clinical trials are needed to elucidate the key mediators in both LR-PRP and LP-PRP to assess their effect on long-term progression of knee OA.
Keywords: inflammation; knee; leukocyte; osteoarthritis; pain; platelet-rich plasma.
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Interesting. So we should flip what we’ve being doing? LR PRP for joints and LP PRP for tendons/ligaments?
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Wow
There is so much unknown and shown in one study but not another. Conclusions can’t be made yet
Many many studies show that the inflammatory cytokines are regulated by the leukocytes.
I’ve seen a basic science study that would show the opposite of this one
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That’s not found in the clinical data
LR for the tendons and ligaments
Wait re read the conclusion it still says MMO higher in LR PRP and that’s been found in other studies
The other conclusion that people are coming around to us that you don’t need to fear the WBCs
They coordinate the healing response as well. Basic premises of inflammatory and anti inflammatory are like thinking of them as fire and ice.
It’s too simplistic
These stages of healing are across a spectrum. And you might need to break down some areas of tissue that are necrotic simultaneously while trying to repair another area adjacent to it
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Sounds like this regen med stuff is truly experimental. But non-deleterious.
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The study was pretty well done.
It does challenge what is being thought of as better therapy.
Now... how to determine if some one has inflammation and should have LR-PRP or not?
It does challenge what is being thought of as better therapy.
Now... how to determine if some one has inflammation and should have LR-PRP or not?
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I don’t think that’s the conclusion.
The exact mechanisms and optimum protocols haven’t been elucidated yet. Clinical studies have mixed data but many well designed studies are very positive.
Much like SCS, DRG Stim, botulinum toxin for migraines, and countless others, we don’t know exactly how they work yet but patients respond beyond placebo
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...some people think that they work by psychokinesis and mind-control...
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Effect of autologous platelet-rich plasma (PRP) on low back pain in patients with prolapsed intervertebral disc: A randomised controlled trial
Prolapsed intervertebral disc (IVDP) is a major cause of low back pain. Platelet-rich plasma (PRP) has emerged as a viable option for these patients, with fewer adverse effects and long-term sustainability of pain relief. This double-blinded, randomised ...
www.ncbi.nlm.nih.gov
Indian J Anaesth. 2023 Mar;67(3):277-282.
doi: 10.4103/ija.ija_821_22. Epub 2023 Mar 16.
Effect of autologous platelet-rich plasma (PRP) on low back pain in patients with prolapsed intervertebral disc: A randomised controlled trial
Girish K Singh 1, Praveen Talawar 1, Ajit Kumar 1, Ravi S Sharma 1, Gaurav Purohit 1, Baibhav Bhandari 1Affiliations expand
- PMID: 37250523
- PMCID: PMC10220156
- DOI: 10.4103/ija.ija_821_22
Abstract
Background and aims: Prolapsed intervertebral disc (IVDP) is a major cause of low back pain. Platelet-rich plasma (PRP) has emerged as a viable option for these patients, with fewer adverse effects and long-term sustainability of pain relief. This double-blinded, randomised study aimed to evaluate the effect of autologous PRP on low back pain in patients with IVDP.Methods: A total of 42 patients with IVDP were randomised either to the autologous PRP (n = 21) group or control (epidural local anaesthetics with steroids; n = 21) group. Change in pain was assessed using the Numeric Rating Scale (NRS). Impact of treatment was assessed using the Global Perceived Effect (GPE) scale. All the patients were followed up for six months. Data was compared using Chi-square, independent sample t, and Mann-Whitney U tests.
Results: The two groups were similar in their demographic and clinical profile. The baseline mean NRS ± standard deviation (SD) was 6.91 ± 0.94 in the PRP group and 7.38 ± 1.16 in the control group (P = 0.099). At six months, the mean NRS ± SD was 1.43 ± 0.75 in the PRP group compared to 5.43 ± 0.75 in the control group (P < 0.001). The GPE score was also found to be significantly higher in the PRP group, compared to the control group in the final assessment (P < 0.001). During the course of the study, the PRP group showed a consistent decline in NRS, whereas the control group showed an initial decline followed by consistent increase in NRS.
Conclusion: PRP provided sustained relief from low back pain due to IVDP and can be recommended as a safe and promising alternative to epidural local anaesthetics and steroids.
Keywords: Low back pain; platelet-rich plasma; prolapsed disc; radiculopathy.
Copyright: © 2023 Indian Journal of Anaesthesia.
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pretty good study.
study does say it is double blinded and randomized.
minor point, but i assumed that all patients had blood drawn, and the injectate was masked to the proceduralist, although it is not completely clear.
all got moderate sedation for the procedure, interestingly.
small sample size but they did perform a power analysis.
study does say it is double blinded and randomized.
minor point, but i assumed that all patients had blood drawn, and the injectate was masked to the proceduralist, although it is not completely clear.
all got moderate sedation for the procedure, interestingly.
small sample size but they did perform a power analysis.
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Clinically if we did nothing, I would expect a group to improve more than the control group.
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I think this study is pretty interesting. I read through it and I don't quite understand what they mean by "peridiscal" did they essentially just do a TFESI with PRP or did they actually go to the disk or angle to where they thought the herniation was. Do you have to have rupture of the annulus for this to work?
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TF with PRP. I wonder if there's any concern of embolus with PRP. @MitchLevi when you did TF blood patches was this ever talked about?
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That topic never came up that I can remember. If it's blood I don't think it's a problem but PRP certainly could be IMO.
I know blood clots quickly and a patch can become congealed but we put an IV line in place, and then would draw from that line and immediately inject it, so really I wouldn't think there's enough time to cause a problem.
Contrast was always used of course.
I think that’s the whole idea behind lysate PRP
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That and apparently it hurts a lot less.
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Expected Critiques:
1) The platelets weren't blinded and therefore biased the patients.
2) The practitioners' magical thoughts and healing intentions affected the cytokines and triamcinolone.
3) Psychokinesis cannot be excluded as a mechanism of action for treatment effects.
4) Nothing works unless it's covered by Medicare. Once Medicare covers it, it will work.
If I were a steroid KOL, I'd be pissed.
Skeletal Radiol. 2023 Jun 2.
doi: 10.1007/s00256-023-04373-w. Online ahead of print.
Affiliations expand
Materials and methods: This single-blind randomized controlled trial was conducted on 60 participants with a clinical diagnosis of SIS from a selected orthopedic clinic. Thirty participants in each arm were given a single dose of either PRP or triamcinolone acetonide into the subacromial sub-deltoid bursa (SASD) under ultrasonography guidance. The outcome variables assessed were the severity score of pain and the degree of shoulder abduction. Post-treatment follow-up was done in 1 week, 3 months, 6 months, and 1 year.
Results: At 1 week, the triamcinolone arm showed a statistically significant reduction of pain (p = 0.039) when compared to PRP. In the long term, PRP showed statistically significant improvement in shoulder abduction, compared to the triamcinolone injection (p = 0.012).
Conclusion: PRP and triamcinolone in the SASD bursa could be considered as safe treatment options for SIS under ultrasonography guidance. While triamcinolone was effective in short-term pain reduction, PRP was effective in long-term improvement in shoulder abduction.
Keywords: Platelet-rich plasma; Shoulder impingement; Supraspinatus tendinopathy.
1) The platelets weren't blinded and therefore biased the patients.
2) The practitioners' magical thoughts and healing intentions affected the cytokines and triamcinolone.
3) Psychokinesis cannot be excluded as a mechanism of action for treatment effects.
4) Nothing works unless it's covered by Medicare. Once Medicare covers it, it will work.
If I were a steroid KOL, I'd be pissed.
Skeletal Radiol. 2023 Jun 2.
doi: 10.1007/s00256-023-04373-w. Online ahead of print.
Effectiveness of single intra-bursal injection of platelet-rich plasma against corticosteroid under ultrasonography guidance for shoulder impingement syndrome: a randomized clinical trial
Padma Badra Hewavithana 1, Mihiri Chami Wettasinghe 2, Gothami Hettiarachchi 1, Manel Ratnayaka 3, Hilary Suraweera 4, Nuwan Darshana Wickramasinghe 5, Pallegoda Vithanage Ranjith Kumarasiri 6Affiliations expand
- PMID: 37266723
- DOI: 10.1007/s00256-023-04373-w
Abstract
Objective: To compare the effectiveness of intra-bursal injection of single-dose platelet-rich plasma (PRP) against corticosteroids under ultrasonography guidance in shoulder impingement syndrome (SIS).Materials and methods: This single-blind randomized controlled trial was conducted on 60 participants with a clinical diagnosis of SIS from a selected orthopedic clinic. Thirty participants in each arm were given a single dose of either PRP or triamcinolone acetonide into the subacromial sub-deltoid bursa (SASD) under ultrasonography guidance. The outcome variables assessed were the severity score of pain and the degree of shoulder abduction. Post-treatment follow-up was done in 1 week, 3 months, 6 months, and 1 year.
Results: At 1 week, the triamcinolone arm showed a statistically significant reduction of pain (p = 0.039) when compared to PRP. In the long term, PRP showed statistically significant improvement in shoulder abduction, compared to the triamcinolone injection (p = 0.012).
Conclusion: PRP and triamcinolone in the SASD bursa could be considered as safe treatment options for SIS under ultrasonography guidance. While triamcinolone was effective in short-term pain reduction, PRP was effective in long-term improvement in shoulder abduction.
Keywords: Platelet-rich plasma; Shoulder impingement; Supraspinatus tendinopathy.
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Not very exciting given the data offered. Better short term pain relief with steroid and better long term ROM in PRP.
Questions:
1. What flavor PRP?
2. What were outcomes at each time point for both?
3. Is the N sufficient to have power to detect a difference?
4. Why not double blind?
5. Why not combine the two in a syringe and create third group in study?
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you forgot to include researcher bias.
single blind studies are much less helpful - it means that only 1 party didnt know what they got, and says nothing about the individual who is making the assessment about whether something benefits or not.
id be wary that they didnt tell the patient what they got, and then looked at all the data and came up with the conclusion that fit with their practice pattern - steroids are better if patients are having pain now, and PRP is better if they can afford it if the patient wants long term benefits
single blind studies are much less helpful - it means that only 1 party didnt know what they got, and says nothing about the individual who is making the assessment about whether something benefits or not.
id be wary that they didnt tell the patient what they got, and then looked at all the data and came up with the conclusion that fit with their practice pattern - steroids are better if patients are having pain now, and PRP is better
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Gigo. 3 doses works as well as one dose. Idiots.
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More evidence for psychokinetic platelets and the peddling of experimental medical treatment on vulnerable patients...
If I were a Medicare-Steroid-KOL, I'd be pissed...
Is Ultrasound (US)-Guided Platelet-Rich Plasma Injection More Efficacious as a Treatment Modality for Lateral Elbow Tendinopathy Than US-Guided Steroid Injection?: A Prospective Triple-Blinded Study with Midterm Follow-up
Lateral elbow tendinopathy (LET) has an array of modalities described for its management. The present study analyzed two modalities used for managing the condition.The present study included 64 non-athletes with LET who failed conservative treatment that ...
www.ncbi.nlm.nih.gov
Randomized Controlled Trial Clin Orthop Surg. 2023 Jun;15(3):454-462. doi: 10.4055/cios22128. Epub 2022 Dec 7.
Is Ultrasound (US)-Guided Platelet-Rich Plasma Injection More Efficacious as a Treatment Modality for Lateral Elbow Tendinopathy Than US-Guided Steroid Injection?: A Prospective Triple-Blinded Study with Midterm Follow-up
Prashant Kamble 1, Rudra Mangesh Prabhu 1, Abhinav Jogani 1, Shubhranshu S Mohanty 1, Sameer Panchal 1, Shubham Dakhode 1
Affiliations expand
PMID: 37274509 PMCID: PMC10232317 DOI: 10.4055/cios22128
Free PMC article
Abstract
Background: Lateral elbow tendinopathy (LET) has an array of modalities described for its management. The present study analyzed two modalities used for managing the condition.
Methods: The present study included 64 non-athletes with LET who failed conservative treatment that included avoiding strenuous activities, ice-fomentation, non-steroidal anti-inflammatory drugs, bracing, and physiotherapy for 6 months. A random allocation of the participants was done, with one group injected with platelet-rich plasma (PRP) and the other group with corticosteroids. The procedure was performed by the same blinded orthopedic surgeon after localizing the pathology using ultrasound. Visual analog scale (VAS) scores, disabilities of the arm, shoulder and hand (DASH) scores, Patient-Rated Tennis Elbow Evaluation (PRTEE) scores, and handgrip strengths were recorded by blinded observers other than the surgeon administering the injection.
Results: The average age of the patients was 40 years. The mean VAS score at the latest follow-up of 2 years in the PRP group was 1.25 and it was significantly better than the score of 3.68 in the steroid group (p < 0.001). The mean DASH score at the latest follow-up of 2 years in the PRP group was 4.00 and it was significantly better than the score of 7.43 in the steroid group (p < 0.001). The mean PRTEE score at the latest follow-up of 2 years in the PRP group was 3.96 and it was significantly better than the score of 7.53 in the steroid group (p < 0.001). The scores were better in the steroid group at a short-term follow-up of 3 months (p < 0.05), while they were better in the PRP group at a long-term follow-up of 2 years (p < 0.05). Hand-grip strength was comparable in the PRP group (84.43 kg force) and steroid group (76.71 kg force) at the end of the 2-year follow-up with no statistically significant difference (p = 0.149).
Conclusions: Corticosteroid injections alleviated symptoms of LET over short-term follow-up providing quicker symptomatic relief; however, the effect faded off over the long term. PRP injections provided a more gradual but sustained improvement over the long-term follow-up, indicating the biological healing potential of PRP.
Keywords: Corticosteroids; Elbow; Platelet-rich plasma; Tendinopathy; Ultrasound.
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Just another day in the Russo clinic. Vita Ray at 100%.
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decent study.
blinded well.
no control group but these patients all tried conservative therapy for 6 months prior...
interesting that the steroid group had average VAS of 3.68 2 years after a single steroid injection. imagine how they would be with more typical treatment including maybe a repeat or two. but then again, with a VAS of 3.68, would that be indicated?
i think i have stated previously that using PRP for lateral epicondylitis seems to be the better treatment option, but the main impediment remains the financial cost of PRP. imagine how many people might be able to continue to work - if their insurance covered PRP - instead of filing for disability...
blinded well.
no control group but these patients all tried conservative therapy for 6 months prior...
interesting that the steroid group had average VAS of 3.68 2 years after a single steroid injection. imagine how they would be with more typical treatment including maybe a repeat or two. but then again, with a VAS of 3.68, would that be indicated?
i think i have stated previously that using PRP for lateral epicondylitis seems to be the better treatment option, but the main impediment remains the financial cost of PRP. imagine how many people might be able to continue to work - if their insurance covered PRP - instead of filing for disability...
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If I were a steroid KOL in a Medicare practice...I'd be pissed...
regenexx.com
When Milligrams Are Toxic: Corticosteroids and Tissue Damage - Regenexx
Regenexx offers non-surgical, regenerative orthopedic treatment options for pain related to osteoarthritis, joint injuries, overuse conditions, spine pain, and common sports injuries.
regenexx.com
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Ridiculous.If I were a steroid KOL in a Medicare practice...I'd be pissed...
When Milligrams Are Toxic: Corticosteroids and Tissue Damage - Regenexx
Regenexx offers non-surgical, regenerative orthopedic treatment options for pain related to osteoarthritis, joint injuries, overuse conditions, spine pain, and common sports injuries.
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If I were a steroid KOL in a Medicare practice...I'd be pissed...
When Milligrams Are Toxic: Corticosteroids and Tissue Damage - Regenexx
Regenexx offers non-surgical, regenerative orthopedic treatment options for pain related to osteoarthritis, joint injuries, overuse conditions, spine pain, and common sports injuries.
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Centeno's position paper.
nothing more, nothing less. move on.
nothing more, nothing less. move on.
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If this doesn't make you believe in the psychokinetic effects of platelet caused by the healing intentions and "good vibes" of regen doctors, then nothing will.
Int J Rheum Dis. 2023 Jun 13.
doi: 10.1111/1756-185X.14781. Online ahead of print.
Inflammatory ultrasound features as prognostic factors of pain and functional outcomes following intra-articular platelet-rich plasma in knee osteoarthritis
Win Min Oo 1 2, James Linklater 3, Kim L Bennell 4, Shirley P Yu 1, Vicky Duong 1, David J Hunter 1Affiliations expand
- PMID: 37309612
- DOI: 10.1111/1756-185X.14781
Abstract
Aim: To explore inflammatory ultrasound predictors of improvements in pain and function over 2, 6, and 12 months following administration of intra-articular platelet-rich plasma (PRP) in knee osteoarthritis (OA).Method: Patients with painful mild-moderate radiographic knee OA from a subset of the RESTORE RCT underwent ultrasound assessment according to the standardized OMERACT scanning protocol to detect inflammatory features such as synovitis, synovial hypertrophy, and effusion with power Doppler. The study knee was treated with 3 once-weekly PRP injections obtained after centrifugation at 1500 g for 5 min. Numerical Rating Score (NRS), Intermittent and Constant Osteoarthritis Pain (ICOAP) questionnaire, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC) function sub-score were used to measure pain and functional severity. Separate linear regression models were performed to determine whether baseline ultrasound-detected features of inflammation predicted the improvement in pain and function following PRP injection in both unadjusted and adjusted models for confounders.
Results: Forty-four participants were included, with 25 (56.8%) being female. In an unadjusted model, higher OMERACT scores for inflammatory features such as global synovitis and/or effusion were significantly associated with greater improvement in all outcomes measured at 2 months but not at 6 and 12 months for pain measures. Only global synovitis showed significant association with functional improvement at 2 and 12 months. Similar findings were observed in the adjusted model.
Conclusion: Ultrasound indices of knee inflammation predicted short-term improvements in pain severity and both short- and longer-term improvements in function following intra-articular PRP injection.
Keywords: disease-modifying osteoarthritis drugs; inflammation; osteoarthritis; platelet-rich plasma; prognosis; ultrasonography; ultrasound.
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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 4Affiliations expand
- PMID: 36752928
- PMCID: PMC9908802
- 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 .
Keywords: Adrenal cortex hormones steroids; Magnetic resonance imaging; Pain; Platelet-rich plasma; Tendinopathy.
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comparing different injections is not really a true comparative study, is it?
one is not using the CS injection (edit) to repair the tear, it is being used for pain solely.
now i dont recommend nor perform CS for tears. but patients with no ability to pay for PRP, then the "treatment" is exercise, stretch, non-opioid pain medication; i can understand why other pain doctors resort to CS injection to provide temporary relief.
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First, do no harm.
Yankees sense 'breakthrough' with Judge's injury
NEW YORK -- Aaron Judge feels like there has been “a little bit of a breakthrough” following the most recent platelet-rich plasma injection on his right big toe, according to manager Aaron Boone, who said that he is hopeful the injured slugger will soon begin to make real progress. There
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A proposed "triple-blind" PRP study protocol for knee OA. A wet dream for @Ducttape @lobelsteve and all the platelet-haters in the house...If I were a hyaluronic acid or saline KOL, I'd be pissed...
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PRP preparation
Step 1: Take three 10 mL EDTA anticoagulant blood collection tubes, draw 30 mL of the participant’s autologous whole blood and count the platelet concentration. Centrifuge at a speed of 500 G in the same direction for 8 min.Step 2: Transfer the upper layer of plasma obtained by the first centrifugation into a sterile centrifuge tube with a pipette. After homogeneous mixing, count the platelet concentration (a) and plasma volume (b). Centrifuge the mixed plasma in the same direction at 1900 G for 12 min to concentrate platelets from plasma.
Step 3: Discard the upper layer of platelet-poor plasma, leaving the lower layer of plasma with a volume of a×b/(1000×109). Disperse and homogeneously mix the platelet pellet which is precipitated at the bottom of the plasma with a sterile pipette, then count the platelet concentration again (by this time it may be approximate 1000×109/L, an error of ±200×109/L is allowed in this study), and finally get the standard PRP. Withdraw 3 mL PRP with a disposable syringe (5 mL) for injection. The PRP will not be activated before injection (figure 2).
Is this the PRP you use DRUSSO?
If I charge $850 for a PRP treatment for partial tear, and downgrade it to $650 in which I lose money, you’re telling me that people can’t afford it, but they would be ok if their ****ty insurance knows that they would pay $20 for a bandaid at a hospital. The people that “can’t afford” could also pay $650 for a number of things that they probably “can’t afford.” What’s Obamas book called..”the audacity of hope” isn’t that title as passive aggressive as I am..
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It's a leukocyte-poor PRP, so yes. But, I would use a higher concentration, typically starting with 60 mL whole blood for one knee.
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How are you pulling off 60 ml? That’s a lot of blood
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I always do 54cc + 6cc anticoagulant.
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I only pull 5 tubes. Single spin. Take the white buffy coat and as little red as I can get. Why are my patients getting cancer and third eyes?
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We call that "ghetto juice" PRP. Weak sauce.
Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020
Emerging autologous cellular therapies that utilize platelet-rich plasma (PRP) applications have the potential to play adjunctive roles in a variety of regenerative medicine treatment plans. There is a global unmet need for tissue repair strategies to ...
www.ncbi.nlm.nih.gov
If I had to review a case where you used ghetto juice and weak sauce PRP, I'd find you negligent and below the standard of care for a regenerative pain specialist...
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Problem is there are no standards. You guys are all over the place. And then charge $4000 for a shot of ghetto juice.We call that "ghetto juice" PRP. Weak sauce.
Platelet-Rich Plasma: New Performance Understandings and Therapeutic Considerations in 2020
Emerging autologous cellular therapies that utilize platelet-rich plasma (PRP) applications have the potential to play adjunctive roles in a variety of regenerative medicine treatment plans. There is a global unmet need for tissue repair strategies to ...
If I had to review a case where you used ghetto juice and weak sauce PRP, I'd find you negligent and below the standard of care for a regenerative pain specialist...
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You would only know the standards if you're competent. Only the competent know the standards. It's Dunning-Kruger in action.
Regenerative Medicine Standards Portal
An interactive database of regenerative medicine standards, including existing and in-development standards and standards areas of need.
Regulatory and Ethical Aspects of Orthobiologic Therapies
Orthobiologic therapies show significant promise to improve outcomes for patients with musculoskeletal pathology. There are considerable research efforts to develop strategies that seek to modulate the biological environment to promote tissue regeneration ...
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Website Physician Reporting Form - Interventional Orthobiologics Foundation
interventionalorthobiologics.org
