Adding Regenerative medicine to your practice.

[drusso]

if you are making so much difference in a lot of lives, shouldnt we be advocating for CMS to allow PRP for all patients with Medicare, and encourage insurances to pay for PRP?

you may be able to offer services to more people and help more people that way.


otherwise, if those who are advocating for PRP only to be self pay are only interested in the money, right?

Stop politicizing platelets.

---

Members don't see this ad.

 

[bedrock]

if you are making so much difference in a lot of lives, shouldnt we be advocating for CMS to allow PRP for all patients with Medicare, and encourage insurances to pay for PRP?

you may be able to offer services to more people and help more people that way.


otherwise, if those who are advocating for PRP only to be self pay are only interested in the money, right?

There are physicians advocating for insurance coverage.

Are you personally meeting with CMS to advocate for better coverage of various treatments?

Otherwise, I’m not sure why you have to crap on physicians treating patients with PRP?

(And if you’re not being a hypocrite to do so?)

 

[Ducttape]

i dont do PRP. i have hit a stone wall with PRP. i refer out of system, even though i have been "counselled".

my advocating to CMS is limited as i am not an expert and have no real world experience with its use.

locally? i am trying to convince admin regarding intracept. i have been successful with MILD. but PRP is a drop dead no, multiple times over.


i am "crapping" on physicians because PRP - while there is evidence that it can be helpful - is being touted as this cure all... but only for those who can afford it.


my opinion is if someone is going to be gung ho and trumpet its benefits, then they should advocate so that everyone can benefit.


you do know from reading any of my posts that i find income disparity and poverty to be a major issue in this country, and am skeptical of differential medical care, part and parcel to finances.

 

[Ducttape]

Stop politicizing platelets.

shouldnt we all get the benefit?

 

[drusso]

shouldnt we all get the benefit?

Uh, no...

 

[Doctodd]

locally? i am trying to convince admin regarding intracept. i have been successful with MILD. but PRP is a drop dead no, multiple times over.

i wonder which one will pay the admin/hospital more? Hmmmmmm

 

[melancholy]

why not? unlike aesthetics, doesnt PRP improve pain and functioning (in certain conditions)?



oh...

its all about the $$$.

which is why I remain skeptical about whether this is the best care to offer people.

I've seen PRP advertised for hair loss lol. I wonder if you can treat the head w PRP for hair loss and migraines (like how some headache sufferers get cosmetic botox and notice it actually helps their migraine)

 

[lobelsteve]

The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial | Bone & Joint

The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial

boneandjoint.org.uk

 

[bedrock]

Steve, I think you might just have to try it for yourself.

In addition to providing this for patients, I've done LP-PRP on myself for two joints. A knee and an ankle. Both joints have mild OA. I had less than 5 days of relief after steroid injection in both joints. However, both joints then achieved 75+% relief for over a year after LP-PRP injection.

 

[drusso]

The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial | Bone & Joint

The effectiveness of leucocyte-poor platelet-rich plasma injections on symptomatic early osteoarthritis of the knee: the PEAK randomized controlled trial

boneandjoint.org.uk

That study has already been debunked and will probably be retracted. That's the ghetto-juice weak sauce PRP study.

The Academic Low Dose PRP Knee OA Problem Is Alive and Well-The Lewis Et al JBJS Paper - 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

 

[lobelsteve]

Steve, I think you might just have to try it for yourself.

In addition to providing this for patients, I've done LP-PRP on myself for two joints. A knee and an ankle. Both joints have mild OA. I had less than 5 days of relief after steroid injection in both joints. However, both joints then achieved 75+% relief for over a year after LP-PRP injection.

That's not science. It is self experimentation. But if my rehab does not get me back to a 10k, I got nothing to lose.

 

[drusso]

That's not science. It is self experimentation. But if my rehab does not get me back to a 10k, I got nothing to lose.

According to scientists, as long as you don't get a ghetto-juice, weak sauce PRP for your knee, it will likely work.

2023 PRP RCT Infographic and Study Failure Analysis - 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

 

[MitchLevi]

I'm prob gonna PRP my elbow soon. Pretty sure a got a case of the ol Gun Fighter's Elbow. I shoot a lot and my elbow has been hurting.

I've used PRP in my right shoulder and left hip flexor. Both times successfully.

 

[Ducttape]

i like it better when you post real studies over infomarketing from centeno.


if you want to market it and sell the product, this is the infomercial you use.

if you want to truly show what the studies represent, then you need to change the graph and add a neutral color for the studies with "not inferior" results.

for example, the first 3 studies should have been in this neutral color, as both PRP and HA improved pain vs control.

in the 4th study, it was a study that looked at HA + PRP, so kind of dubious to market it as a comparative study...

 

[lobelsteve]

https://a.co/d/aWZoaMe

I'm ready to rock and roll.

 

[drusso]

Because there is zero evidence platelet counts matter but it sounds good when up-selling a customer(patient) to supersize their McPRP order.

Some have argued that orthobiologic dose does not matter to which I say, "Pound sand."

Angiogenesis and Tissue Repair Depend on Platelet Dosing and Bioformulation Strategies Following Orthobiological Platelet-Rich Plasma Procedures: A Narrative Review

Angiogenesis is the formation of new blood vessel from existing vessels and is a critical first step in tissue repair following chronic disturbances in healing and degenerative tissues. Chronic pathoanatomic tissues are characterized by a high number of inflammatory cells; an overexpression of...

www.mdpi.com

 

[nvrsumr]

Awesome narrative review...

Every author of that "study" should do the easily blinded RTC of different "dosing" with whole blood as a control... with the usual functional outcome measures

Maybe their IRB wont allow due to the possible harm of too low a "dose"?! haha

 

[Ducttape]

tommy tuberville clearly believes in orthobiologics...

Republican senator's stock trade linked to Ukraine war raises eyebrows

Tommy Tuberville bought stock in an obscure biotech firm just before it reached its highest price in months.

www.newsweek.com

 

[drusso]

Awesome narrative review...

Every author of that "study" should do the easily blinded RTC of different "dosing" with whole blood as a control... with the usual functional outcome measures

Maybe their IRB wont allow due to the possible harm of too low a "dose"?! haha

Dose matters...just say "no" to ghetto-juice, weak-sauce, PRP.

Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy - Scientific Reports

Despite encouraging results reported with regards to Platelet-rich plasma (PRP) application in osteoarthritis (OA) knee, still critical issues like conclusive structural evidence of its efficacy, standard dose and good manual method of preparation to obtain high yield remains unanswered. Present...

www.nature.com

Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy​

• Himanshu Bansal,
• Jerry Leon,
• Jeremy L. Pont,
• David A. Wilson,
• Anupama Bansal,
• Diwaker Agarwal &
• Iustin Preoteasa

Scientific Reports volume 11, Article number: 3971 (2021) Cite this article

Abstract​

Despite encouraging results reported with regards to Platelet-rich plasma (PRP) application in osteoarthritis (OA) knee, still critical issues like conclusive structural evidence of its efficacy, standard dose and good manual method of preparation to obtain high yield remains unanswered. Present study is an attempt to optimise the dose and concentration of therapeutic PRP and its correlation with structural, physiologic efficacy with a new manual method of PRP preparation. A total of one hundred and fifty patients were randomized to receive either PRP (10 billion platelets) or hyaluronic acid (HA; 4 ml; 75 patients in each group) and followed up till 1 year. An addition of filtration step with 1 µm filter in manual PRP processing improved platelet recovery upto 90%. Significant improvements in WOMAC (51.94 ± 7.35 vs. 57.33 ± 8.92; P < 0.001), IKDC scores (62.8 ± 6.24 vs 52.7 ± 6.39; P < 0.001), 6-min pain free walking distance (+ 120 vs. + 4; P < 0.001) persisted in PRP compared to HA group at 1 year. Significant decline IL-6 and TNF-α levels observed in PRP group (P < 0.05) compared to HA at 1 month. Study demonstrated that an absolute count of 10 billion platelets is crucial in a PRP formulation to have long sustained chondroprotective effect upto one year in moderate knee OA.

 

[Ducttape]

um... a lot wrong with the study.

they talk about placebo group but i see no documentation of the characteristics of this group. no patients got a control dose of saline alone.

there is no way of determining if a higher dose and concentration of PRP is better, which is the claim, because they did not study different doses of PRP - they only studied the one dose against HA. so how can they say that 10 billion platelets is better than, say, 8 billion or 1 billion?

in addition, they used 8 ml of PRP but only 4 ml of HA. could volume of injectate make a difference?




if they had wanted to use this study to say that PRP is more effective long term than HA, then this study design would have worked fine (with the possible exception of differing volumes of injectate) and they could publish good results.

instead, it seems they wanted to take it a step further, and that step is fraught with problems...

 

[drusso]

um... a lot wrong with the study.

they talk about placebo group but i see no documentation of the characteristics of this group. no patients got a control dose of saline alone.

there is no way of determining if a higher dose and concentration of PRP is better, which is the claim, because they did not study different doses of PRP - they only studied the one dose against HA. so how can they say that 10 billion platelets is better than, say, 8 billion or 1 billion?

in addition, they used 8 ml of PRP but only 4 ml of HA. could volume of injectate make a difference?




if they had wanted to use this study to say that PRP is more effective long term than HA, then this study design would have worked fine (with the possible exception of differing volumes of injectate) and they could publish good results.

instead, it seems they wanted to take it a step further, and that step is fraught with problems...

The point of this study is that an absolute platelet count is more important than a concentration multiple over baseline. In this study, the PRP would have been a respectable 6-7X concentration over baseline. I think better outcomes are achieved with close to 10-14X. But, maybe 10 billion platelets is the magic number regardless of the concentration of PRP. I'm open to that.

Why would volume matter? If anything, higher volumes cause painful capsular distension. But I've never met a knee that can't handle 8-10 mL of anything.

 

[lobelsteve]

The point of this study is that an absolute platelet count is more important than a concentration multiple over baseline. In this study, the PRP would have been a respectable 6-7X concentration over baseline. I think better outcomes are achieved with close to 10-14X. But, maybe 10 billion platelets is the magic number regardless of the concentration of PRP. I'm open to that.

Why would volume matter? If anything, higher volumes cause painful capsular distension. But I've never met a knee that can't handle 8-10 mL of anything.

PRP Calc2

Acceptable method to you?

 

[Ducttape]

The point of this study is that an absolute platelet count is more important than a concentration multiple over baseline. In this study, the PRP would have been a respectable 6-7X concentration over baseline. I think better outcomes are achieved with close to 10-14X. But, maybe 10 billion platelets is the magic number regardless of the concentration of PRP. I'm open to that.

Why would volume matter? If anything, higher volumes cause painful capsular distension. But I've never met a knee that can't handle 8-10 mL of anything.

Using different volumes may affect results.

You mention that you've never met a knee that can't handle 8 ml volume.

Suppose that 4 ml was insufficient to spread the HA to all parts of the joint. Or that the extension is what expands tissue and that has a positive effect on pain.

Again, to say a certain number of platelets is beneficial over a different number in a study that did not compare different doses of platelets is an assumption that they cannot make, as there is no comparator.

 

[drusso]

Using different volumes may affect results.

You mention that you've never met a knee that can't handle 8 ml volume.

Suppose that 4 ml was insufficient to spread the HA to all parts of the joint. Or that the extension is what expands tissue and that has a positive effect on pain.

Again, to say a certain number of platelets is beneficial over a different number in a study that did not compare different doses of platelets is an assumption that they cannot make, as there is no comparator.

Explain how volume affects results.

 

[drusso]

PRP Calc2

Acceptable method to you?

I've never used that method. Have they published results?

 

[Ducttape]

Explain how volume affects results

Sentence 3 and 4 in previous post.

Med maybe doesn't get spread to entire joint. Or distension of joint may help with pain.

AJRoentgenography recommends 9 ml injectate.

In fact, some PRP studies have shown that volumes of 8 to 10 ml are better than 4 ml. I believe you may have already posted one of those studies...


And speaking of previous studies - this one you just posted is from 2021.

2 years ago. There may be newer studies out there....

 

[drusso]

Ann Med Surg (Lond). 2023 Aug 3;85(9):4385-4388.
doi: 10.1097/MS9.0000000000001115. eCollection 2023 Sep.

Platelet-rich plasma versus corticosteroid: a randomized controlled trial on tennis elbow patients resistant to nonsurgical treatments​

Shahram Sayadi 1, Parmida Shahbazi 2 3, Arvin Najafi 2, Fatemeh Ochi 2, Kyana Jafarabady 4, Mohammad M Rezaei 4, Salman Azarsina 2
Affiliations expand

• PMID: 37663722
• PMCID: PMC10473312
• DOI: 10.1097/MS9.0000000000001115

Abstract​

Background: Although some studies on tennis elbow indicate corticosteroid (CS) effectiveness in the short term, according to the role of race, this study evaluates the efficacy of platelet-rich plasma (PRP) compared with CS for a more cost-effective treatment.
Methods: This randomized controlled trial included 30 positive-resisted wrist extension patients with a minimum five visual analog scale (VAS) pain score. Participants were randomly assigned to treatment or control groups via computer-generated randomization and were matched for baseline and clinical characteristics. Cases received either 40 mg of prednisolone acetate or 2 ml of PRP, followed for 1 month. VAS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were the primary outcomes.
Results: The median VAS and the mean DASH scores had a statistically significant difference in the PRP and CS groups before and after injection (P<0.001).The mean DASH difference between preinjection and follow-up time in the PRP and CS groups was 59.72±14.17 and 43.16±10.87, respectively, with a mean difference of 16.55 (95% CI 7.10-26.00) and a significant difference (P=0.001).The mean VAS pain score difference in preinjection and follow-up time had a statistically significant difference between the PRP and CS groups (P=0.026), and the mean VAS pain score difference in the CS group was 6.46±1.50 and 7.73±0.96 in the PRP group.
Conclusion: In conclusion, larger studies with parallel groups and more diverse CS doses and types with baseline matching are needed to confirm the short-term benefits of PRP. Investigating the effects of different CS doses using ultrasound techniques is recommended.
Keywords: corticosteroids; platelet-rich plasma; randomized controlled trials; tennis elbow.
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

This study found that PRP injections were more effective than CS injections in reducing VAS pain and DASH scores after 1 month, although both treatments resulted in improved outcomes (either in pain or function) compared to preinjection scores.

The Disabilities of the Arm, Shoulder, and Hand (DASH) score is a self-report questionnaire designed to measure physical function and symptoms in people with any of several musculoskeletal disorders of the upper limb. The DASH questionnaire consists of 30 items, and the score can range from 0 to 100. A higher DASH score indicates a greater disability, while a lower score suggests a lower level of disability.

 

[lobelsteve]

Ann Med Surg (Lond). 2023 Aug 3;85(9):4385-4388.
doi: 10.1097/MS9.0000000000001115. eCollection 2023 Sep.

Platelet-rich plasma versus corticosteroid: a randomized controlled trial on tennis elbow patients resistant to nonsurgical treatments​

Shahram Sayadi 1, Parmida Shahbazi 2 3, Arvin Najafi 2, Fatemeh Ochi 2, Kyana Jafarabady 4, Mohammad M Rezaei 4, Salman Azarsina 2
Affiliations expand

• PMID: 37663722
• PMCID: PMC10473312
• DOI: 10.1097/MS9.0000000000001115

Abstract​

Background: Although some studies on tennis elbow indicate corticosteroid (CS) effectiveness in the short term, according to the role of race, this study evaluates the efficacy of platelet-rich plasma (PRP) compared with CS for a more cost-effective treatment.
Methods: This randomized controlled trial included 30 positive-resisted wrist extension patients with a minimum five visual analog scale (VAS) pain score. Participants were randomly assigned to treatment or control groups via computer-generated randomization and were matched for baseline and clinical characteristics. Cases received either 40 mg of prednisolone acetate or 2 ml of PRP, followed for 1 month. VAS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores were the primary outcomes.
Results: The median VAS and the mean DASH scores had a statistically significant difference in the PRP and CS groups before and after injection (P<0.001).The mean DASH difference between preinjection and follow-up time in the PRP and CS groups was 59.72±14.17 and 43.16±10.87, respectively, with a mean difference of 16.55 (95% CI 7.10-26.00) and a significant difference (P=0.001).The mean VAS pain score difference in preinjection and follow-up time had a statistically significant difference between the PRP and CS groups (P=0.026), and the mean VAS pain score difference in the CS group was 6.46±1.50 and 7.73±0.96 in the PRP group.
Conclusion: In conclusion, larger studies with parallel groups and more diverse CS doses and types with baseline matching are needed to confirm the short-term benefits of PRP. Investigating the effects of different CS doses using ultrasound techniques is recommended.
Keywords: corticosteroids; platelet-rich plasma; randomized controlled trials; tennis elbow.
Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.

View attachment 376439

This study found that PRP injections were more effective than CS injections in reducing VAS pain and DASH scores after 1 month, although both treatments resulted in improved outcomes (either in pain or function) compared to preinjection scores.

The Disabilities of the Arm, Shoulder, and Hand (DASH) score is a self-report questionnaire designed to measure physical function and symptoms in people with any of several musculoskeletal disorders of the upper limb. The DASH questionnaire consists of 30 items, and the score can range from 0 to 100. A higher DASH score indicates a greater disability, while a lower score suggests a lower level of disability.

VAS was not clinically different between the two groups. DASH was better after 1 month for PRP than steroid, but both were clinically improved.

 

[drusso]

Randomized Controlled Trial

BMC Musculoskelet Disord. 2023 Apr 28;24(1):335.
doi: 10.1186/s12891-023-06429-3.

"Platelet-Rich Plasma" epidural injection an emerging strategy in lumbar disc herniation: a Randomized Controlled Trial​

Asarn Wongjarupong 1, Saran Pairuchvej 2, Panyajarn Laohapornsvan 1, Vit Kotheeranurak 1, Khanathip Jitpakdee 1, Chunrutai Yeekian 1, Pongsthorn Chanplakorn 3
Affiliations expand

• PMID: 37118707
• PMCID: PMC10141936
• DOI: 10.1186/s12891-023-06429-3

Free PMC article

Abstract​

Background: Lumbar herniated disc (HNP) is mainly treated by conservative management. Epidural steroid injection (ESI) has been an option to treat failed cases prior to surgery. Triamcinolone has been widely used due to its efficacy in bringing about pain reduction for up to three months. However, several reports have shown some severe adverse events. Platelet-rich plasma (PRP) is made from blood through centrifugation. Several studies supported the potential short to long-term effects, and safety of PRP injection in treating HNP. The study objective was to evaluate the efficacy of PRP in treatment of single-level lumbar HNP in comparison to triamcinolone.
Methods: Thirty patients were treated by transforaminal epidural injections. PRP was obtained from 24 ml venous blood through standardized double-spin protocol. Participants included fifteen patients each being in triamcinolone and PRP groups. The same postoperative protocols and medications were applied. The visual analogue scale of leg (LegVAS), collected at baseline, 2, 6, 12, and 24 weeks, was the primary outcome. The BackVAS, Oswestry Disability Index (ODI), adverse event, and treatment failure were the secondary endpoints.
Results: Platelet ratio of PRP in fifteen patients was 2.86 ± 0.85. Patients treated by PRP injections showed statistically and clinically significant reduction in LegVAS at 6, 12, and 24 weeks, and in ODI at 24 weeks. It demonstrated comparable results on other aspects. No adverse event occurred in either group.
Conclusion: Noncommercial epidural double-spin PRP yielded superior results to triamcinolone. Due to its efficacy and safety, the procedure is recommended in treating single level lumbar HNP.
Trial registration: NCT, NCT05234840. Registered 1 January 2019, CTG Labs - NCBI .

Keywords: ESI; Lumbar HNP; PRP; Platelet-rich plasma; Triamcinolone; VAS.

• LegVAS: Both triamcinolone and PRP treatment groups showed a significant improvement in LegVAS from baseline to all other time points. However, the PRP treatment group showed a slightly greater improvement in LegVAS at all time points, with the difference being statistically significant at 24 weeks.
• BackVAS: Both triamcinolone and PRP treatment groups showed a significant improvement in BackVAS from baseline to all other time points. However, the difference between the two treatment groups was not statistically significant at any time point.
• ODI: Both triamcinolone and PRP treatment groups showed a significant improvement in ODI from baseline to all other time points. However, the PRP treatment group showed a slightly greater improvement in ODI at all time points, with the difference being statistically significant at 24 weeks.

The results suggest that triamcinolone and PRP treatment effectively improve LegVAS, BackVAS, and ODI in patients with herniated lumbar discs. However, PRP treatment may be slightly more effective than triamcinolone treatment, especially at 24 weeks.

 

[Ducttape]

- do you offer epidural injections 24 weeks (6 months) apart?

if i remember correctly, you were on the side defending epidural injections against naysayers who noted that they did not provide long term (ie longer than 12 weeks) benefit.

- someone with severe pain, this graph looks like you should offer them the CS epidural, as they will have greater pain relief at 2 weeks..

- study group was very small - 15 patients.

this is important because of the study groups, there were 2 (out of 30 total) treatment failures, both with the CS group. those 2 failures could completely explain the difference between the 2 groups.



- finally, the graphs are misleading. the horizontal access is more of a logarithmic scale than a linear one...

 

[drusso]

Dose matters...Just say "no" to weak sauce, ghetto juice PRP...


Acta Orthop Traumatol Turc. 2023 Jul;57(4):148-153.
doi: 10.5152/j.aott.2023.22077.

Factors affecting the features of platelet-rich plasma in patients with knee osteoarthritis​

Sezen Karaborklu Argut 1, Derya Celik 2, Omer Naci Naci Ergin 2, Onder Ismet Kilicoglu 3
Affiliations expand

• PMID: 37670448
• DOI: 10.5152/j.aott.2023.22077

Abstract​

Objective: The aim of this study was to present an analysis of platelet-rich plasma obtained from patients with knee osteoarthritis and reveal the factors affecting its features.
Methods: A total of 62 patients (mean age: 56.68 ± 7.13 years) with symptomatic knee osteoarthritis were included in this study. Age (years), gender, height (m), weight (kg), body mass index (kg/m2), duration of symptoms, smoking status, smoking index, general health status, and physical activity scores were recorded. Whole blood and platelet-rich plasma cell counts were performed with a hematology analyzer. White blood cell, red blood cell, and platelet counts were recorded. According to the dose of injected platelets, efficiency of the procedure, purity of platelet-rich plasma, and activation classification, dose of platelets, efficiency of the procedure (platelet recovery rate, %), and purity of the obtained platelet-rich plasma product (relative composition in platelets, %) were calculated. Correlation analysis between the features of platelet-rich plasma and the patient-related variables, including age, gender, body mass index, smoking status, smoking index, presence of other health conditions, physical activity scores, duration of symptoms, and pain levels, was performed.
Results: Dose of injected platelets, efficiency of the procedure, purity of platelet-rich plasma, and activation analysis showed that the dose of injected platelets was 3.25 billion, the efficiency of the process was 77%, and the purity rate of the platelet-rich plasma was 98.4%. Platelet-rich plasma platelet count was correlated with whole blood platelet count (r = 0.81, P < .001), whole blood white blood cell count (r = 0.39, P = .002), smoking status (r = 0.56, P = .03), smoking index (r = -0.63, P = .002), and the presence of hypertension (r = -0.31, P=.04). Platelet-rich plasma white blood cell and purity of platelet-rich plasma were correlated with the smoking status of the patients (r = 0.52, P = .01; r = 0.64, P = .003, respectively).
Conclusion: This study has demonstrated that high dose and very pure platelet-rich plasma with medium efficiency was yielded with this platelet-rich plasma preparation procedure; whole blood platelet count, the presence of hypertension, and the smoking status of patients affect the features of the obtained platelet-rich plasma.
Level of evidence: Level IV, Diagnostic Study.

Key takeaways:

• Platelet count in whole blood (Wb_Plt) strongly correlates with platelet count in PRP (PRP_Plt). This is expected, as PRP is prepared by centrifuging whole blood to enrich the platelet fraction.
• White blood cell count in whole blood (Wb_WBC) and red blood cell count in whole blood (Wb_RBC)** are also correlated with PRP_Plt, but to a lesser extent. This suggests that other factors, such as the centrifugation protocol, may also play a role in determining PRP_Plt.
• Platelet distribution width (Wb_Pdw) is negatively correlated with PRP_Plt. This means that patients with narrower platelet distributions tend to have higher PRP_Plt.
• Gender, age, and BMI correlate with PRP_Plt, but the correlations are weaker.
• Dose of injected platelets, process efficiency, and PRP purity are all positively correlated. This suggests that these factors are all important for achieving high-quality PRP.

The heatmap shows that several patient-related variables correlate with PRP quality. This suggests that it is crucial to consider these variables when preparing PRP for clinical use.

Here are some specific recommendations for how the heatmap can be used to improve PRP quality:

• Select patients with high platelet counts and narrow platelet distributions.
• Use a centrifugation protocol that is optimized for platelet enrichment.
• Monitor the efficiency of the PRP preparation process and make adjustments as needed.
• Use a quality control protocol to ensure that the PRP is pure and meets all required standards.

 

[drusso]

J Clin Med. 2023 Aug 26;12(17):5554.
doi: 10.3390/jcm12175554.

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

Grayson Poff 1, Edwin Spencer 1, Benson Scott 1, Robert Sleadd 1, John Broyles 1
Affiliations expand

• PMID: 37685621
• DOI: 10.3390/jcm12175554

Abstract​

Platelet-rich plasma injections have been shown to have many useful applications in various musculoskeletal pathologies. Research on the use of PRP for intrasubstance partial-thickness rotator cuff tears is lacking, although these tears have unique properties that may increase the efficacy of platelet-rich plasma injections.

Patients with MRI-confirmed high-grade intrasubstance partial-thickness rotator cuff tears, that had failed traditional non-operative treatment, were offered either surgical repair (Group 1) or a single ultrasound-guided platelet-rich plasma injection into the tear site (Group 2). Patients were followed at 2 weeks, 6 weeks, 3 months, and a minimum of 2 years post-injection with ASES scores.

A total of 25 patients received platelet-rich plasma injections, compared to 20 patients who had rotator cuff repair for intrasubstance tears in the last 3 years. The mean pre-injection ASES score for the platelet-rich plasma group was 53.2 and this improved to 92.9 at a minimum 2-year follow-up. The average convalescence period following platelet-rich plasma injection was 3.3 months. The average post-operative convalescence period for arthroscopic rotator cuff repair was 4.6 months.

Both surgical repair and platelet-rich plasma injection into the tear site are equally effective in the treatment of high-grade intrasubstance partial-thickness rotator cuff tears, while platelet-rich plasma provides significantly shorter recovery time.

Keywords: PRP; clinical outcomes; intrasubstance rotator cuff tears; partial rotator cuff tears; platelet-rich plasma; rotator cuff repair; rotator cuff tears.

 

[Ducttape]

wow, looks nice!

lets review it...

1. single location
2. retrospective study
3. they were all offered PRP injection first, as part of the protocol. then an MRI scan was done and they recieved treatment. then the study was done.
4. the PRP group was 45 years old from 16 to 62, more male than female. the surgery group averaged 56, from 40 to 72, split male-female.
5. no ASES data at 6 weeks, 3 months, or 6 months. hard to compare that recovery time is that much shorter if functional data is not included.

As seen in Table 1, the average primary outcome ASES score improved from 53.2 at baseline to 76 at six weeks, 85 at three months, 91.8 at one year, and 95.3 at 2 years post-injection.

As seen in Table 3, the average ASES score for Group 2 was 52.0 pre-op, 92.9 at one year, and 96.5 at 2 years post-op.

6. here is the study's claim to fame:

As seen in Table 3, the average time from the injection to return to activity for Group 1 was 3.3 months, while the average time from surgery to return to activity in Group 2 was 4.6 months.

yet, in their retrospective protocol, patients were not allowed to do any strengthening or exercise for the initial 2-4 weeks. where patients were told to not do any rehabilitative treatment in the PRP group for "the first few days".
7. the researchers do admit that they have no evidence that the PRP injections "healed" the condition. there was no follow up MRI.
8. their conclusions in the article are reasonable, even though the study is limited. the big graph is a little deceiving.

 

[lobelsteve]

 

[drusso]

View attachment 377085

There is nothing new under the sun. Everything about Regen has already been proven. For decades, we've used PRP and BMAC in equine veterinary medicine, wound care, and burn medicine. I'm amused that anyone still gets their panties in a bind about it.

 

[MitchLevi]

View attachment 377085

 

[drusso]

J Craniomaxillofac Surg. 2023 Oct 7:S1010-5182(23)00189-0.
doi: 10.1016/j.jcms.2023.09.014. Online ahead of print.

Platelet-rich plasma therapy for temporomandibular joint osteoarthritis: A randomized controlled trial​

Sha-Sha Liu 1, Li-Li Xu 1, Li-Kun Liu 2, Shen-Ji Lu 1, Bin Cai 3
Affiliations expand

• PMID: 37852892
• DOI: 10.1016/j.jcms.2023.09.014

Abstract​

The study aimed to compare the efficacy of platelet-rich plasma (PRP) injections for the treatment of temporomandibular joint osteoarthritis (TMJ-OA) with hyaluronic acid (HA) therapy. This randomized controlled trial included 70 patients with TMJ-OA, randomly divided into either a PRP or HA group. The pain intensity, maximum mouth opening (MMO), TMJ sound score, and proportion of crepitus were recorded and compared at baseline and at 1, 3, and 6 months. Both groups showed statistically significant improvements in pain intensity, MMO, TMJ sound, and scale scores during the 6-month follow-up period. The improvements in pain intensity during mouth opening at 1 month, MMO at 1, 3, and 6 months, TMJ sound score at 1 and 3 months, and GAD-7 score at 6 months in the PRP group were greater than in the HA group (p < 0.05). Compared with the HA group, imaging improvement in the PRP group was also higher (p < 0.05). Within the limitations of the study it seems that the application of PRP therapy in TMJ-OA is should be considered whenever possible.

Keywords: Hyaluronic acid; Injection; Osteoarthritis; Platelet-rich plasma; Temporomandibular joint.

 

[drusso]

Orthop J Sports Med. 2023 Sep 11;11(9):23259671231184400.
doi: 10.1177/23259671231184400. eCollection 2023 Sep.

https://journals.sagepub.com/doi/10.1177/23259671231184400

Safety and Efficacy of Bone Marrow-Derived Mesenchymal Stem Cells for Chronic Patellar Tendinopathy (With Gap >3 mm) in Patients: 12-Month Follow-up Results of a Phase 1/2 Clinical Trial​

Robert Soler 1, Gil Rodas 2 3, Joan Rius-Tarruella 1, Xavier Alomar 4, Ramon Balius 5, Ángel Ruíz-Cotorro 6 7, Lorenzo Masci 8, Nicola Maffulli 9 10 11, Lluís Orozco 1
Affiliations expand

• PMID: 37711505
• PMCID: PMC10498712
• DOI: 10.1177/23259671231184400

Free PMC article

Abstract​

Background: In a previous study, the authors found that at 6 months after treatment with a 20 × 106 dose of bone marrow-derived mesenchymal stem cells (BM-MSCs), patients showed improved tendon structure and regeneration of the gap area when compared with treatment using leukocyte-poor platelet-rich plasma (Lp-PRP). The Lp-PRP group (n = 10), which had not seen tendon regeneration at the 6-month follow-up, was subsequently offered treatment with BM-MSCs to see if structural changes would occur. In addition, the 12-month follow-up outcomes of the original BM-MSC group (n = 10) were evaluated.
Purpose: To evaluate the outcomes of all patients (n = 20) at 12 months after BM-MSC treatment and observe if the Lp-PRP pretreated group experienced any type of advantage.
Study design: Cohort study; Level of evidence, 2.
Methods: Both the BM-MSC and original Lp-PRP groups were assessed at 12 months after BM-MSC treatment with clinical examination, the visual analog scale (VAS) for pain during daily activities and sports activities, the Victorian Institute of Sport Assessment-Patella score for patellar tendinopathy, dynamometry, and magnetic resonance imaging (MRI). Differences between the 2 groups were compared with the Student t test.
Results: The 10 patients originally treated with BM-MSCs continued to show improvement in tendon structure in their MRI scans (P < .0001), as well as in the clinical assessment of their pain by means of scales (P < .05). Ten patients who were originally treated with Lp-PRP and then with BM-MSCs exhibited an improvement in tendon structure in their MRI scans, as well as a clinical pain improvement, but this was not significant on the VAS for sports (P = .139). Thus, applying Lp-PRP before BM-MScs did not yield any type of advantage.
Conclusion: The 12-month follow-up outcomes after both groups of patients (n = 20) received BM-MSC treatment indicated that biological treatment was safe, there were no adverse effects, and the participants showed a highly statistically significant clinical improvement (P < .0002), as well as an improvement in tendon structure on MRI (P < .0001). Preinjection of Lp-PRP yielded no advantages.
Keywords: jumper’s knee; mesenchymal stem cells; patellar tendinopathy; regenerative medicine; sports injury.

 

[lobelsteve]

Orthop J Sports Med. 2023 Sep 11;11(9):23259671231184400.
doi: 10.1177/23259671231184400. eCollection 2023 Sep.

https://journals.sagepub.com/doi/10.1177/23259671231184400

Safety and Efficacy of Bone Marrow-Derived Mesenchymal Stem Cells for Chronic Patellar Tendinopathy (With Gap >3 mm) in Patients: 12-Month Follow-up Results of a Phase 1/2 Clinical Trial​

Robert Soler 1, Gil Rodas 2 3, Joan Rius-Tarruella 1, Xavier Alomar 4, Ramon Balius 5, Ángel Ruíz-Cotorro 6 7, Lorenzo Masci 8, Nicola Maffulli 9 10 11, Lluís Orozco 1
Affiliations expand

• PMID: 37711505
• PMCID: PMC10498712
• DOI: 10.1177/23259671231184400

Free PMC article

Abstract​

Background: In a previous study, the authors found that at 6 months after treatment with a 20 × 106 dose of bone marrow-derived mesenchymal stem cells (BM-MSCs), patients showed improved tendon structure and regeneration of the gap area when compared with treatment using leukocyte-poor platelet-rich plasma (Lp-PRP). The Lp-PRP group (n = 10), which had not seen tendon regeneration at the 6-month follow-up, was subsequently offered treatment with BM-MSCs to see if structural changes would occur. In addition, the 12-month follow-up outcomes of the original BM-MSC group (n = 10) were evaluated.
Purpose: To evaluate the outcomes of all patients (n = 20) at 12 months after BM-MSC treatment and observe if the Lp-PRP pretreated group experienced any type of advantage.
Study design: Cohort study; Level of evidence, 2.
Methods: Both the BM-MSC and original Lp-PRP groups were assessed at 12 months after BM-MSC treatment with clinical examination, the visual analog scale (VAS) for pain during daily activities and sports activities, the Victorian Institute of Sport Assessment-Patella score for patellar tendinopathy, dynamometry, and magnetic resonance imaging (MRI). Differences between the 2 groups were compared with the Student t test.
Results: The 10 patients originally treated with BM-MSCs continued to show improvement in tendon structure in their MRI scans (P < .0001), as well as in the clinical assessment of their pain by means of scales (P < .05). Ten patients who were originally treated with Lp-PRP and then with BM-MSCs exhibited an improvement in tendon structure in their MRI scans, as well as a clinical pain improvement, but this was not significant on the VAS for sports (P = .139). Thus, applying Lp-PRP before BM-MScs did not yield any type of advantage.
Conclusion: The 12-month follow-up outcomes after both groups of patients (n = 20) received BM-MSC treatment indicated that biological treatment was safe, there were no adverse effects, and the participants showed a highly statistically significant clinical improvement (P < .0002), as well as an improvement in tendon structure on MRI (P < .0001). Preinjection of Lp-PRP yielded no advantages.
Keywords: jumper’s knee; mesenchymal stem cells; patellar tendinopathy; regenerative medicine; sports injury.

N=10. Why does the world of regenmed not power studies to be useful.

 

[Ducttape]

N=10. Why does the world of regenmed not power studies to be useful.

its easier to fudge find positive results when the numbers involved are miniscule.

with regards to the study -

they say they are comparing - i guess they are comparing to the baseline? there is no placebo group, so the results may be not completely accurate.

interestingly, pretreating with PRP resulted in a non-clinically significant improvement in VAS.

from the original study, as stated in this paper:

There were no significant differences in patient-reported outcomes (visual analog scale [VAS] for pain or Victorian Institute of Sport Assessment–Patella [VISA-P] score) between the study groups,24 indicating that injections of BM-MSCs or Lp-PRP, together with rehabilitation, were both effective in chronic refractory patellar tendinopathy to reduce pain and improve activity levels in these patients.

so what was the effect of 1 year of rehab on the overall study indices?


other side note - these of course were all athletes, young, healthy with normal BMI.

all patients got better. they state that PRP prior to BM isnt indicated, but even those who got PRP then BM improved.



i kind of read this in another way - that the authors want you to believe that BM is better, and there really is no reason to do PRP if BM is available...

 

[Doctodd]

N=10. Why does the world of regenmed not power studies to be useful.

actually you are only 100% off.......N=20

 

[Doctodd]

its easier to fudge find positive results when the numbers involved are miniscule.

with regards to the study -

they say they are comparing - i guess they are comparing to the baseline? there is no placebo group, so the results may be not completely accurate.

interestingly, pretreating with PRP resulted in a non-clinically significant improvement in VAS.

from the original study, as stated in this paper:

so what was the effect of 1 year of rehab on the overall study indices?


other side note - these of course were all athletes, young, healthy with normal BMI.

all patients got better. they state that PRP prior to BM isnt indicated, but even those who got PRP then BM improved.



i kind of read this in another way - that the authors want you to believe that BM is better, and there really is no reason to do PRP if BM is available...

after 6 and 12 months?!?!

Must be easy to fudge an MRI image.

 

[Ducttape]

MRI reads are interpretive.

unlike a sodium level or a TSH.

N=20 for the entire study.

N=10 for the part of the arm that got BM from the start and N=10 for the group that got PRP then after 6 months changed to BM.

 

[drusso]

N=10. Why does the world of regenmed not power studies to be useful.

Because there is no commercial interest or deep pockets. Only you own your platelets.

 

[Doctodd]

MRI reads are interpretive.

I skimmed the free article. It doesn’t seem like they just did a quick interpretation. They also measured lesion size….

“The MRI scans (Vantage Galan 3-T; Canon Medical) were performed using various sequences (coronal T2-weighted gradient echo, 0.5-mm slice thickness; sagittal proton-density [PD] fat-saturated, 2-mm slice thickness; coronal PD fat-saturated, 1.5-mm slice thickness; axial PD fat-saturated, 2-mm slice thickness; and sagittal T2-weighted mapping, fast spin-echo T2 with 4 echo times 20, 60, 100, and 140 milliseconds for parametric reconstruction image) on all study patients during the first evaluation before treatment as well as at the 3-, 6-, and 12-month follow-up visits. In addition to measuring lesion size (longitudinal, transverse, anteroposterior) and volume, we graded the following MRI parameters as per our previous study24 on a 0- to 100-point scale, with 100 indicating complete restoration of the tendon structure:
1.
Lesion size on coronal T2-weighted fat-saturated image (no lesion = 40 points; ≤3-mm gap = 30 points; >3- to 6-mm gap = 20 points; >6- to 10-mm gap = 10 points; and >10-mm gap = 0 points)
2.
Appearance of homogeneous tissue and passage of fibers/fascicles on sagittal and coronal T2-weighted fat-saturated images (32 points)
3.
Hypersignal on coronal T2-weighted spin-echo image (10 points)
4.
Edema of the Hoffa body on sagittal and axial T2-weighted fat-saturated images (9 points)
5.
Bone edema of the lower patella on sagittal and axial T2-weighted fat-saturated images (9 points)
This scoring system was devised by us and was validated by 4 independent radiologists.24”

 

[Ducttape]

i did not mention quick.

i mentioned that reads are interpretive. the radiologist gets to decide where to exactly measure, and to what degree they think there is edema, etc.


since we are going off on tangents, i would like to remind you that the results of MRI do not necessarily represent patient symptoms.

 

[lobelsteve]

Because there is no commercial interest or deep pockets. Only you own your platelets.

You getting stem cells from platelets?

If only there was money in the lies told to patients.

 

[MitchLevi]

Seen today in follow up, 5 weeks after common hamstring tendon injection under US guidance. Leukocyte Poor PRP, Accelerated Biologics. Large kit yielding 7cc from 54cc blood and 6cc anticoagulant. Injected 1.5-2 cc at 3 sites. Discarded approximately 2cc of waste.

Nasty right hamstring tear, along with severe lumbar stenosis and right sacroiliitis. He has a substantial gait dysfxn after somewhere around 7 or 8 left hip surgeries (3-4 replacements at this point, with the 1st in the 1970s after an MVC) and bilateral TKA.

Right SIJ CSI fantastic for his SI pain, and this hamstring tendon PRP is 85% helpful at 5 weeks.

He is right leg reliant, and his left leg isn't much assistance. Right leg basically does all the work.

Lumbar stenosis isn't symptomatic, or at least it hasn't clearly declared itself.

 

[drusso]

Foot Ankle Surg.

2023 Oct 14:S1268-7731(23)00192-3.
doi: 10.1016/j.fas.2023.10.004. Online ahead of print.

Botulinum toxin A versus platelet rich plasma ultrasound-guided injection in the treatment of plantar fasciitis: A randomised controlled trial​

Isabel M Ruiz-Hernández 1, Javier Gascó-Adrien 2, Carmen Buen-Ruiz 3, Laura Perelló-Moreno 4, Carmen Tornero-Prieto 4, Gonzalo Barrantes-Delgado 2, Mireia García-Gutiérrez 3, J M Rapariz-González 4, S Tejada-Gavela 5
Affiliations expand

• PMID: 37949704
• DOI: 10.1016/j.fas.2023.10.004

Abstract​

Background: Platelet-rich plasma (PRP) and botulinum toxin type A (BTX-A) injections have proven effective in clinical trials for plantar fasciitis treatment but have not been directly compared. We aimed to compare clinical outcomes in patients undergoing PRP or BTX-A injections.
Methods: We performed a randomised controlled trial (59 patients; 1-year follow-up) to assess efficacy, using pain and functional scales (VAS, AOFAS Hindfoot-scale and FAAM questionnaire) and fascia thickness reduction, in control and single ultrasound-guided BTX-A or PRP injection groups.
Results: The BTX-A group showed better results at 1-month after treatment. Conversely, the PRP injection was more effective in the long-term, with significant pain reduction and functional improvement. Plantar fascia thickness significantly reduced from months 1 and 3 in the PRP and BTX-A groups, respectively.
Conclusion: PRP and BTX-A injections are effective in patients with plantar fasciitis with BTX-A achieving better short-term pain reduction and PRP better long-term results.
Level of evidence: Level I; Randomised Controlled Trial.
Keywords: Botulinum toxin A; Injection; Plantar fasciitis; Platelet-rich plasma; Ultrasonography.

Copyright © 2023 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

 

[lobelsteve]

Just finishing up my articles for MOCA/ABPMR 2023. One of the articles to read and answer questions was on ACR Guidelines for OA. PRP/Stem Cells: STRONGLY RECOMMENDED AGAINST.