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Regenerative Research Roundup - July 2023




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 optimal PRP composition for soft tissue applications; PRP vs. CS for frozen shoulder; PRP with microfracture; and ultrasound indicators for PRP efficacy in knee OA.

Let's dive in!


 

Angiogenesis and Tissue Repair Depend on Platelet Dosing and Bioformulation Strategies Following Orthobiological Platelet-Rich Plasma Procedures. A Narrative Review (Pre-Print)

PRE-PRINT // LOE: lV


This review article provides helpful insights into the importance of cellular composition, primarily platelet dose, of PRP to deliver optimal outcomes. The focus of this review is on soft tissue applications, however, much of these findings translate well to all applications including joint pathologies.

Of note, this article is currently available only as a pre-print. However, several of these authors are widely published and their thoughts should be well received by anybody interested in adhering to PRP best practices.


3.2 billion platelets are necessary to achieve positive outcomes in soft tissue applications. This translates to roughly 3ml of 4.5x PRP.


Authors have indicated a dose-response curve by which PRP produces positive outcomes. Studies involving greater than 3.2 x 10^9 platelets have generally reported more positive results. In addition, nearly all the studies with positive results used a PRP product with leukocytes (LR-PRP).

 

Comparing the Efficacy of Intra-articular Platelet- Rich Plasma and Corticosteroid Injections in the Management of Frozen Shoulder: A Randomized Controlled Trial

Cureus // LOE: l

Periarthritis of the shoulder, or frozen shoulder (FS), is a common, painful, and disabling condition with varied treatment strategies. Intra-articular (IA) corticosteroid (CS) injections are a popular treatment option, but their efficacy is often temporary.

In this prospective, randomized study, 68 patients who met the inclusion criteria were enrolled and randomized using a computer-generated table into two groups: Group 1 (IA PRP) received 4 ml PRP (not characterized), and Group 2 (IA CS) received 2 ml (80 mg) of methylprednisolone acetate mixed with 2 ml normal saline (for a total of 4 ml) as a CS injection in the IA area of the shoulder.


Authors results found that the IA PRP injections demonstrated better long-term outcomes (up to 24 weeks) than the IA CS injections, significantly improving pain, shoulder ROM, and daily activity performance.


 


Platelet rich plasma combined with arthroscopic microfracture versus arthroscopic microfracture alone for the treatment of knee cartilage injury


AM J Transl Res // LOE: ll


This RCT investigated the clinical efficacy of platelet-rich plasma (PRP) injection combined with arthroscopic microfracture technique in treating knee cartilage injury

Of 120 patients, 55 cases underwent the arthroscopic microfracture technique alone (control group), and the other 65 cases underwent PRP (4x concentrated) combined with the arthroscopic microfracture technique (observation group). The visual analogue scale (VAS) score, Lysholm knee joint score, MRI image indexes, the incidence of adverse events, and patient satisfaction during treatment were compared between groups before and after surgery.




Authors found that at 12 months after surgery, the subchondral bone marrow oedema volumes and bone marrow defect areas in the observation group were smaller than those in the control group; while repaired cartilage thicknesses of the observation group were more significant than those of the control group (all P<0.05).

 

Inflammatory ultrasound features as prognostic factors of pain and functional outcomes following intra-articular platelet-rich plasma in knee osteoarthritis


Cartilage // LOE: lV


This study is to be taken with a grain of salt, as it is based off the RESTORE study which failed to produce significant outcomes with PRP in Knee OA, due to using regenlab PRP at 1.9x concentration.

That being said, this particular study may provide some meaningful insights into diagnostic predictors of outcomes with ultrasound - a common tool used in clinical diagnosis for knee pathologies.

Patients with painful mild-moderate radiographic knee OA from a subset of the RESTORE RCT underwent ultrasound assessment according to the standardized OMERACT scanning protocol to detect inflammatory features such as synovitis, synovial hypertrophy, and effusion with power Doppler.

In an unadjusted model, higher OMERACT scores for inflammatory features such as global synovitis and/or effusion were significantly associated with greater improvement in all outcomes measured at 2 months but not at 6 and 12 months for pain measures. Only global synovitis showed significant association with functional improvement at 2 and 12 months. Similar findings were observed in the adjusted model.


 

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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