Welcome to the Regenerative Research Roundup, where we look through recently published research and bring you the best of the best in a quick-to-read digest.
This month, we're reviewing PRP for lateral epicondylitis as determined by repeated MRI; PRP lysate for discogenic LBP; PRP for non-specific LBP; and PRP for chronic lumbar discogenic back pain.
Repeated magnetic resonance imaging at six follow-up visits over a 2-year period after platelet-rich plasma injection in patients with lateral epicondylitis
Journal of Shoulder and Elbow Surgery // Level of Evidence: ll
While the efficacy of PRP for Lateral Epicondylitis is well understood when the proper PRP preparation is used, most high-level clinical evidence does not include medical imaging as one of their reported outcomes.
In this study, thirty patients underwent PRP treatment for lateral epicondylitis and received sequential MRIs at 1, 3, 6, 12, 18, and 24 months. VAS and PRTEE were the other outcome scores reported at the same time points. The authors claim that their method of PRP preparation produced 2 ml leukocyte-enriched PRP with platelets 5x baseline used in an inactivated manner.
Authors reported continuous tendon recovery as determined by MRI throughout the 2 year follow-up period in addition to significant improvements in VAS and PRTEE. Of note is that MRI score improvement continued longer than clinical scores, suggested a continued healing process after patient perception of improvement ends.
Effect of platelet-rich plasma injections for chronic nonspecific low back pain: A randomized controlled study
Journal of Medicine // Level of Evidence: l
This study was a prospective, double-blind, randomized controlled trial that was conducted over a 3 year period - it evaluated patients with chronic, non-specific, low back pain that were refectory to conventional management and ligamentous in nature.
Thirty four patients were randomly allocated to receive either PRP or lidocaine injections in the lumbopelvic ligaments for 2 weeks and then weekly prolotherapy for 2 weeks. PRP was prepared using a dual-spin method with 5-6ml of total injectate available.
Although the authors did not definitively rule out the source of back pain as discogenic, they did find that PRP outperformed lidocaine injections for the patient population.
ACCESS HERE: https://pubmed.ncbi.nlm.nih.gov/35212300/
Platelet-Rich Plasma-Releasate (PRPr) for the Treatment of Discogenic Low Back Pain Patients: Long-Term Follow-Up Survey
Medicina // Level of Evidence: ll
Authors of this study used a dual-spin LP-PRP lysate in the treatment of 14 patients suffering from discogenic low back pain. PRP lysate is a preparation method in which the platelets are activated and the serum containing the released growth factors is collected for injection.
This study was performed over many years with an average final survey date of 5.9 years. VAS and RDQ were the collected outcome scores while disc height was a secondary endpoint. Ultimately, authors found dramatic improvement in the reported clinical scores for more than 90% of subjects.
We're starting to see the use of PRP lysate over standard PRP in nerve-related pathologies more often in literature. This may be due to the ability of PRP lysate to deliver a greater dose of growth factors at once, versus the sustained release over ~1 hour that occurs with standard PRP.
ACCESS HERE: https://www.mdpi.com/1648-9144/58/3/428/htm
Clinical outcomes following intradiscal injections of higher-concentration platelet-rich plasma in patients with chronic lumbar discogenic pain
International Orthopaedics // Level of Evidence: lll
This is a follow-up study to one performed by the authors in 2021 that looked at the use of intradiscal PRP injections for the treatment of chronic lumbar discogenic back pain. In the aforementioned study, authors used a PRP preparation that contained 5x baseline platelets while in this study, authors concentrated the product up to 10x baseline by reducing 60mL of whole blood down to 4mL of injectate.
37 patients were enrolled in the study to receive the high-concentration PRP and clinical outcome scores (visual numerical pain score, Functional Rating Index [FRI], and NASS Patient Satisfaction Index) were compared against the historical cohort.
Authors found a significant improvement in pain scores, FRI scores and overall patient satisfaction in the group that received the 10x PRP than the historical cohort. While not conclusive, this study suggests that "super concentrating" your PRP may offer improved patient response.
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