Orthopedic
Some of the information contained on this webpage pertains to products, indications for use of products and/or therapies that are only available outside the United States and have not been approved or cleared for marketing by the United States Food & Drug Administration.
Berghoff WJ, Pietrzak WS, Rhodes RD. Platelet-rich plasma application during closure following total knee Arthroplasty. Orthopedics 2006;29:590.
Summary: A study group of 71 patients undergoing total knee arthroplasty on a total of 81 knees received application of platelet-rich and platelet-poor plasma during the surgical procedure. This study group was compared to a historical control group of 66 patients (72 knees) and found to have a shorter hospital stay, improved range of motion, and a more stable hemodynamic profile, resulting in a need for fewer blood transfusions.
Quotation: "In this retrospective 6-week study, total knee arthroplasty patients treated with platelet-rich and platelet-poor plasma during wound closure demonstrated shortened hospital stay, improved range of motion, improved hemoglobin profile, and reduced need for blood transfusion compared to control patients who received no platelet-rich or platelet-poor plasma treatment."
Everts PM, Devilee RJ, Mahoney CB, et al. Platelet gel and fibrin sealant reduce allogeneic blood transfusions in total knee arthroplasty. Acta Anaesthesiol Scand 2006;50:593-599.
Summary: Platelet gel and autologous fibrin sealant were applied to 85 patients undergoing a total knee arthroplasty and compared to 80 patients undergoing the same surgical protocol without the use of platelet gel and fibrin sealant. The group receiving platelet gel and fibrin sealant had decreased blood transfusion requirements, lower incidence of post-operative wound healing disturbances, less infections, and a shorter length of hospital stay.
Quotation: "In conclusion, in patients undergoing total knee arthroplasty, we demonstrated that the exogenous application of platelet gel and fibrin sealant to the wound site supported the haemostatic condition with the delivery of concentrated platelet growth factors and leucocytes."
Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. AJSM 2006;34(11):1774-8.
Summary: A single injection of PRP was investigated as a treatment for chronic elbow tendinosis. Eight weeks post-injection, the 20 study patients demonstrated a 60% improvement in their visual analog pain score compared to a 16% improvement for a control group. At 6 months, the treated patients noted an 81% improvement and at a final follow-up (25.6 month average), the reduction in the pain score was 93%. The authors concluded that the treatment of chronic elbow tendinosis with PRP reduced pain significantly with no reported adverse events.
Quotation: "In the present investigation, the PRP-treated patients demonstrated significant improvement with a single injection that was sustained over time with no reported complications."
Sanchez M, Anitua E, Azofra J, et al. Comparison of surgically repaired achilles tendon tears using platelet-rich fibrin matrices. AJSM 3007;35:245-251.
Summary: 6 athletes had platelet rich plasma applied to the suture site during open suture repair of achilles tendon tear. The athletes receiving PRP were compared to a matched control group of 6 athletes receiving standard treatment during open suture repair of a achilles tendon tear. The PRP group recovered their range of motion earlier, took less time to take up gentle running and was quicker to return to training activities compared to the control group. There were no wound complications in the PRP group compared to a superficial wound infection and two keloids reported in the control group
Quotation: "Based on this preliminary study, we suggest that the operative management of achilles tendon tears associated with the application of autologous platelet-rich fibrin could present new possibilities for enhanced healing and functional recovery."
Ventura A, Terzaghi C, Borgo E, et al. Use of growth factors in ACL surgery. J Orthopaed Traumatol 2005;6:76-79.
Summary: 20 patients were treated with quadrupled hamstring tendon graft with or without the application of platelet rich plasma. The platelet rich plasma was sprayed into the femoral and tibial tunnels during the procedure. At 6 months, functional outcomes were similar between the two groups. Analysis of CT images taken at 6 months demonstrated that the PRP group had ACL's that were more uniform in density, better structured, and better filled the femoral and tibial tunnels when compared to the control group.
Quotation: "We observed that the transformation from autologous quadrupled hamstring tendon graft to new ACL was faster in the growth factor-treated group than in controls."
www.springerlink.com/content/x810g036w0871507
Benefit of percutaneous injection of autologous platelet-leukocyte-rich gel in patients with delayed union and nonunion
Bielecki T, Gazdzik TS, Szcepanski T. Eur Surg Res 2008;40(3):289-296.
Summary: 12 patients with delayed union and 20 patients with nonunion of a fracture received percutaneous injection of platelet rich plasma. All 12 patients with a delay union went on to union with a average time to union of 9.3 weeks after the injection. 13 of the 20 patients with nonunion went on to union with a average time to union of 10.3 weeks after the injection. The seven patients when union was not seen, were all greater then 11 months removed from the original fracture. It was concluded that percutaneous injection of platelet rich plasma was a safe and efficacious treatment for delayed union as well as cases of nonunion that were less then 11 months removed from the original fracture.
Quotation: "We believe that percutaneous autologous platelet-leukocyte-rich gel grafting can be an effective and safe method for the treatment of delayed union and for selected cases of nonunion."
Randelli PS, Arrigoni P, Cabitza P, Volpi P, Maffulli N. Autologous platelet-rich plasma for arthroscopic rotator cuff repair. A pilot study. Disabil Rehabil 2008 May 19:1-6 [Online first article]
Summary: In a case study involving 14 patients, autologous platelet-rich plasma (PRP) was applied in 14 patients undergoing arthroscopic rotator cuff repair. In the 13 patients that completed follow-up through 24 months, VAS scores dropped from a pre-operative average level of 5.31±1.84 down to 0.57±0.76 at six months. The average VAS score at 24 months was 1.00±0.58. UCLA scores also improved from 16.54±5.46 preoperative to 32.92±1.19 at 24 months post-operative, and mean constant scores improved from a pre-operative value of 54.62±16.98 to 85.23±7.22 at the 24-month follow-up. No local or general complications were noted during surgery or throughout the follow-up period.
Quotation: “This study demonstrates that the use of autologous PRP in combination with autologous thrombin between the bone and the cuff repair is safe and effective: During the course of the study, no adverse event related to the application of these products was observed. The application of PRP produced clinical abandon of the sling.”
Radice F, Yanez R, Gutierrez V, Pinedo M, Rosales J, Coda S. Uso de concentrado autologo rico en factores de crecimiento en la reconstrucción del LCA. Revista Argentina de Artroscopy 2008;14(2): pages unknown.
RESUMEN: Hipótesis: La aplicación de factores de crecimiento obtenidos de concentrado plaquetario autólogo al injerto al efectuar la reconstrucción de ligamento cruzado anterior en deportistas, afecta positivamente el proceso de remodelación del injerto utilizado. Objetivo: Determinar el efecto que tiene en el proceso de remodelación del injerto, la aplicación de factores de crecimiento obtenidos de concentrado plaquetario autólogo al efectuar la reconstrucción de ligamento cruzado anterior en deportistas. Diseño del estudio: Prospectivo, clínico randomizado, con grupo control y ciego simple. Método: Se realiza en forma prospectiva el análisis de 50 reconstrucciones de LCA en 50 pacientes, todas ellas realizadas por el mismo equipo quirúrgico. Al grupo A , además de efectuar la reconstrucción de LCA, se adiciona Concentrado Plaquetario Autólogo, desarrollando una técnica de aplicación que permite estandarizar la dosis de concentrado empleada y evitar la pérdida de este en el paso del injerto a través de los túneles óseos. Los pacientes del grupo A se sometieron a estudio de resonancia magnética en forma seriada a los 3, 4, 5, 6, 7, 8 y 9 meses postoperatorio. El grupo control el estudio se realizó a los 3, 4,6, 7, 9,10 ,11 ,12 meses. La evaluación de las placas obtenidas fue realizada por un solo radiólogo en forma ciega, ya que desconocía: tiempo de evolución, técnica quirúrgica empleada o si se aplicó AGF. Analisis Estadístico: Comparación de Grupos: T-Student (p-value < 5%) y Prueba F (p-value < 5%).Modelo Cuadrático Predictivo de Tiempo de Maduración (Homogeneidad) para determinar el tiempo de remodelación y maduración en cada grupo. Resultados: El puntaje promedio de maduración al momento de la resonancia magnética, entregado por el radiólogo en el grupo A fue de 1,14 y en el grupo B (control) fue de 3,25.Ambos grupos son comparables según sexo y edad (p-value < 5%). El tiempo de maduración del segmento intraarticular, en el grupo A (con adición de AGF) alcanzó los 177 días posterior a la cirugía. En el grupo B (control) fue de 369 días. Esto determina injertos maduros, en el caso de pacientes con factores de crecimiento, en la mitad del tiempo (49,4%) que injertos sin Factores de crecimiento (p-value 0,000). Conclusiones: La aplicación de factores de crecimiento obtenidos de concentrado plaquetario autólogo al injerto al efectuar la reconstrucción de ligamento cruzado anterior en deportistas, afecta positivamente el proceso de remodelación del injerto utilizado acortando el tiempo normal de maduración en un 49.4%
Radice F, Yanez R, Gutierrez V, Pinedo M, Rosales J, Coda S. Use of autologous growth-factor-rich concentrate in ACL reconstruction. Revista Argentina de Artroscopy 2008;14(2): pages unknown.
NOTE: Original article was in Spanish. A professional translation was done by Quest Technology, Inc.
Summary: The effect of autologous platelet concentrate on graft remodeling after anterior cruciate ligament (ACL) surgery was examined in a randomized single-blinded trial of 50 patients (25 treatment, 25 control). The mean graft maturation time in the group that received platelet concentrate application (treatment group) was 177 days, vs. 369 days in the control group, in which conventional surgical and closure techniques were used. The authors state that this reduced maturation time has allowed athletes to return to their sport an average of two months earlier.
Quotation: “The results, somewhat surprisingly, showed a significant shortening of the biological maturation time of the graft, to at least 49%. This means that the used graft could undergo its complete process in half the time it naturally requires. This is significant news, since a professional athlete could return to sport between the 4th and 5th month.”
Not available on PubMed
Sampson S, Gerhardt M, Mandelbaum B. Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med 2008 July 16 [Online first article]
Summary: This article discusses platelet and growth factor science and reviews available literature on the use of platelet-rich plasma (PRP) in various orthopedic applications, including for lateral epicondylitis, plantar fasciitis, patellar tendonitis, knee arthroplasty, chronic wound healing, and spinal fusion.
Quotation: “The authors are currently expanding PRP injection applications from tendon injuries to other persistent ailments including greater trochanteric bursitis and knee osteoarthritis with favorable results. The authors also have had success in injecting professional soccer athletes with acute MCL knee injuries in an effort to accelerate their return to play.”