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Regenerative Research Roundup - January 2024




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 cover a number of exciting studies in the space of PRP and Adipose; including PRP for KOA, CADTH Reviews, and more!


Let's dive in!


 

The Impact of Blood Morphological Parameters on Treatment Outcomes in Tennis ElbowPatients Receiving Platelet-Rich Plasma (PRP) Therapy: A Prospective Study

Cureus // LOE: III


We have known for some time that WBCs and their sub-groups play an important role in mediating the inflammatory process and are important components of PRP treatment for soft tissue injuries.

 

A prospective analysis was conducted on 107 patients (132 elbows) undergoing lateral epicondylitis treatment with (PRP) injections. The objective of the study was to assess whether there are correlations between the levels of individual morphotic elements determined in whole blood and the outcomes of tennis elbow treatment with PRP injection, as measured using patient-reported outcome measures (PROMs) such as the Visual Analog Scale (VAS), Quick Disabili- ties of the Arm, Shoulder, and Hand (QDASH), and Patient-Rated Tennis Elbow Evaluation (PRTEE).

 

Authors found that WBC subgroups - eosinphils (EOS) and basophils - were correlated with patients that had MCID in outcomes. Furthermore, the size of platelets may play a more important role than the quantity. However, it should be noted that none of the raw data for this PRP characterization was provided.


 

Platelet-Rich Plasma Therapy: An Effective Approach for Managing Knee Osteoarthritis

Cureus // LOE: IV


This meta-analysis covers a popular topic - PRP for knee osteoarthritis. However, in addition to rounding up a number of popular articles on the subject, further classified the articles by PRP type, concentration, and dose. These are important criteria for evaluating the outcomes of any PRP study.

 

What authors found was that of course, PRP therapy slowed down KOA progression, which validates its effectiveness in impeding further structural damage and arresting the degenerative impact of the disease. Additionally, PRP was effective in treating KOA when the mean platelet concentration of PRP treatment was 4.83 to 5.91 times higher than the baseline whole blood platelet concentration. However, studies investigating PRP with a mean platelet concentration of 3.48 to 4.04 times higher than baseline failed to demonstrate statistically significant improvements.

 

What is interesting is that upon further review of the included studies, nearly all studies that used PRP's dosed lower than ~3x baseline did not achieve a statistically significant result. So, it would stand to reason that the authors conclusion may be amended to studies with a mean platelet concentration of <4.04 times higher than baseline failed to demonstrate improvement.

 


CADTH Health Technology Reviews: PRP for Chronic Tendinopathies in Upper Extremities and Lower Back Pain


Canadian Agency for Drugs and Technologies in Health


CADTH, or the Canadian Agency for Drugs and Technologies in Health, provides guidance on the use of health technologies with a particular focus on cost efficacy and reimbursement. As PRP is not currently funded under the public health system, when CADTH publishes, we must take notice. However, none of the prior CADTH reviews have provided any degree of support for PRP on the basis of currently available clinical evidence - most likely due to the problem of studies with too short of a follow up or under-dosed PRP making their way into the review.

 

Nonetheless, CADTH just published two reviews - PRP for Chronic Tendinopathies in Upper Extremities and PRP for Lower Back Pain. While in both cases the authors conclude that there is a high-degree of variability in outcomes, there are positive takeaways.

 

In the case of PRP for Chronic Tendinopathies, CADTH found that studies describing pain suggested there may be potential for a benefit of PRPi with higher concentrations of leukocytes or longer durations of follow-up.

 

For PRP for lower back pain, CADTH concluded that Platelet-rich plasma injections (PRPIs) might be better than other injections (including steroid injections) for patients with lower back pain in reducing pain and enhancing patient satisfaction, without increasing the risk of major complications or serious adverse events.

ACCESS HERE:


 

Adipose Tissue-Derived Minimally Manipulated Products versus Platelet-Rich Plasma for the Treatment of Knee Osteoarthritis: A Systematic Review of Clinical Evidence and Meta-Analysis

 

Journal Clin. Med. // LOE: IV


Minimally manipulated adipose tissue (MM-AT) products are gaining attention as a potential treatment for knee osteoarthritis (OA). These products are easy to use and take advantage of the properties of adipose tissue.

 

The review included 33 clinical studies of varying types, such as prospective and retrospective case series, randomized controlled trials (RCTs), and comparative studies. The studies showed overall clinical improvement and few minor adverse events. When comparing MM-AT and PRP injections, the results were similar . However, the review also highlighted the limitations of the current literature, with only a few high-level trials and generally low quality.

 

 

PRP continues to be a reliable first-line therapy for knee OA due to its well-documented benefits and safety profile. Meanwhile, adipose-derived stem cells from MM-AT are still being investigated for their potential added benefits. As research progresses, we may see MM-AT products becoming a more prominent part of knee OA treatment strategies. However, until more high-quality trials are conducted, PRP will likely remain the go-to treatment.

 

 

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 cdowns@mdbiologix.com

Cheers!

Connor

 

This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and any related subjects. The views and opinions expressed in this post are those of the author and may not reflect the views and opinions of MDBiologix. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if any treatment is right for you.

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