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 have studies on using PRP to augment ACL reconstruction; PRP for LDH; CADTH review of PRP for tendinopathies; and PRP for Ankle OA
Let's dive in!
Effect of platelet-rich plasma on healing of autologous graft after anterior cruciate ligament reconstruction: a randomized control trial
Future Medicine // LOE: l
The use of PRP in intra-operative orthopaedic procedures has been sparing, given the heterogeneity of outcomes and lack of defined protocols.
However, this RCT demonstrated favourable results when using PRP in combination with an autologous graft in ACL reconstructive surgery.
87 patients were sub-divided into PRP and non-PRP groups. MRI and functional outcome measures were used to evaluate graft healing. The PRP group exhibited superior clinical and radiological outcomes compared with the non-PRP group. Authors concluded that PRP is a helpful intra-operative biologic to improve graft healing and patient outcomes.
ACCESS HERE: https://doi.org/10.2217/rme-2023-0108
“Platelet-Rich Plasma” epidural injection an emerging strategy in lumbar disc herniation: a Randomized Controlled Trial
BMC // LOE: l
Given the sparsity in data involving PRP for intra-discal, epidural, or other axial modalities, it is always worth sharing an RCT that covers these applications.
In this RCT, authors administered PRP following a dual-spin technique into the epidural space of fifteen patients suffering from a lumbar disc herniation. The PRP was below <4x concentration, which is surprising given their technique of spinning the product twice and reducing the volume from 24ml to 3ml. There may be a sampling error here. Perhaps what is more noteworthy is that the PRP product had a high-concentration of leukocytes.
Among patients that received the PRP injection vs. control (triamcinolone), results demonstrated a statistically and clinically significant reduction in LegVAS at 6, 12, and 24 weeks.
It would be interesting to see how these results would improve if the authors used a product that delivered an even higher dose of platelets, in the realm of >10x baseline as it the protocol followed by established author Dr. Greg Lutz using the KeyPRP system.
ACCESS HERE: https://doi.org/10.1186/s12891-023-06429-3
Platelet-Rich Plasma Injections for Chronic Tendinopathies in the Lower Extremities
CADTH // LOE: IV
CADTH is an independent, not-for-profit organization responsible for providing health care decision-makers with objective evidence to help make informed decisions about the optimal use of health technologies. In this review, they seek to understand the implications for PRP in chronic tendinopathies.
Unfortunately, the depth of this review does not reach the level necessary to understand the impact of platelet dose and leukocyte concentration on tendon healing - which is now well understood among PRP experts. We published a narrative review of this exact application last month that covers this topic.
Authors of this CADTH review included papers that used products <2x baseline with little to no leukocytes, which of course clouded the big picture with outcomes that demonstrate inefficacy of the product.
This review is a step-backwards for Canadian orthobiologics and highlights the importance of industry to self-police studies and applications of PRP. Enforcing best practices such as using PRP technologies that deliver a concentration of platelets AT LEAST 5x above baseline, with the right concentration of leukocytes depending on the application.
Platelet-Rich Plasma Injections for the Treatment of Ankle Osteoarthritis
AOSSM // LOE: l
This is a study that we've seen before, and discussed in our blog post "How to evaluate PRP Research: The Good, The Bad, and The Ugly". I'm highlighting it here again as it surprised me to see a journal such as the AOSSM accepting this manuscript despite the backlash received when JAMA published it a year prior.
In summary, authors used the Arthrex ACP system to deliver 2ml of ~2x baseline PRP to the Ankle joint in the treatment of Osteoarthritis. Over a year follow-up period, no notable outcomes were achieved. This of course is unsurprising, as we know that a minimum concentration of 5x is necessary to deliver positive outcomes in patients suffering from osteoarthritis.
As mentioned previously, it is critical for the industry to self-police this as journals and independent review boards often overlook these small but critical details.
ACCESS HERE: https://doi.org/10.1177/0363546523118243
If you have any questions or comments regarding the above research, or are wondering how you can apply it to your regenerative practice, please leave a comment below or shoot me an email at firstname.lastname@example.org
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