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 PRP dosing for KOA; PRP for lateral epicondylitis; and 4-year data on MFAT at BMAC.
Let's dive in!
Comparison of Conventional Dose Versus Superdose Platelet-Rich Plasma for Knee Osteoarthritis
The Orthopaedic Journal of Sports Medicine // LOE: I
It is commonly understood that there is a minimum concentration of platelets required to achieve positive patient outcomes across all applications of PRP.
This randomized clinical trial compared the efficacy of two different dosages of platelet-rich plasma (PRP) injections for early knee osteoarthritis (OA). In the study, 50 knees received a conventional 4 mL PRP injection (group A), and 49 knees received an 8 mL injection (group B). The mean absolute platelet count injected was 2.82 billion in group A and 5.65 billion in group B.
The results showed that both groups experienced significant improvement, but group B had notably better results and higher patient satisfaction. However, group B also had more short-term complications such as pain and stiffness. This suggests that increasing the PRP dosage improved the treatment's efficacy.
However, the authors could have potentially achieved the same increase in total platelets by increasing the concentration rather than the volume, which is often limited by the injection site. This would possibly have offered the benefits seen in group B without the associated increase in complications.
ACCESS HERE: https://doi.org/10.1177/23259671241227863
Platelet-Rich Plasma Has Better Results for Long-term Functional Improvement and Pain Relief for Lateral Epicondylitis: A Systematic Review and Meta-analysis of Randomized Controlled Trials
The American Journal of Sports Medicine // LOE: I
This meta-analysis contrasted the efficacy of two treatments for lateral epicondylitis (commonly known as tennis elbow): platelet-rich plasma (PRP) and corticosteroids (CS). The research encompassed a review of 11 studies involving 730 patients.
Initially, CS demonstrated superior performance in terms of swift pain alleviation and functional improvement within a short-term period (less than 2 months). However, in the long-term perspective (6 months or more), PRP outperformed CS, showing significant improvements in pain reduction and enhanced functionality of the arm, shoulder, and hand.
In the intermediate-term (2-6 months), the difference in pain reduction between the two treatments was not significantly discernible. Therefore, while CS may provide immediate symptomatic relief, PRP offers more sustainable benefits in terms of functional improvement and pain relief over an extended period.
In conclusion, while both treatments have their merits, PRP emerges as the superior option for long-term management of lateral epicondylitis. This suggests that clinicians should consider PRP as a preferred option when developing long-term treatment strategies for patients with this condition.
ACCESS HERE: https://doi.org/10.1177/03635465231213
Platelet-Rich Plasma, Bone Marrow Aspirate Concentrate, and Hyaluronic Acid Injections Outperform Corticosteroids in Pain and Function Scores at a Minimum of 6 Months as Intra-Articular Injections for Knee Osteoarthritis: A Systematic Review and Network Meta-Analysis
Arthroscopy // LOE: II
This research aimed to compare the effectiveness of common intra-articular injections used in treating knee osteoarthritis, including corticosteroid (CS), hyaluronic acid (HA), platelet-rich plasma (PRP), and bone marrow aspirate concentrate (BMAC). The study, following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, involved a comprehensive review of 48 studies comprising 9,338 knees.
The most studied injection was HA, followed by placebo, PRP, CS, and BMAC. Both HA and PRP significantly improved pain compared to placebo, while HA, PRP, and BMAC significantly improved function scores. An analysis of the cumulative ranking curves (SUCRAs) showed that PRP, BMAC, and HA had the highest likelihood of improving both pain and function, with PRP scoring the highest.
In conclusion, at a minimum 6-month follow-up, PRP demonstrated significantly improved pain and function for patients with knee osteoarthritis compared with placebo. Furthermore, PRP had the highest overall SUCRA values for these outcomes when compared with BMAC, HA, and CS, suggesting that PRP is the most effective treatment among the intra-articular injections studied.
ACCESS HERE: https://doi.org/10.1016/j.arthro.2024.01.037
Autologous microfragmented adipose tissue treatment of knee osteoarthritis demonstrates effectiveness in 68% of patients at 4-year follow-up
Archives of Ortho. And Trau. Surgery // LOE: I
Long-term data extending to 4 years is unusual but valuable in evaluating treatment options for knee osteoarthritis (OA). This study examined the medium-term effectiveness and safety of Microfragmented Autologous Fat Tissue (MFAT) injection treatment for knee OA at a 4-year follow-up.
In this prospective trial, 46 patients with symptomatic knee OA, who had failed to respond to previous conservative measures, underwent diagnostic arthroscopy and a single autologous MFAT injection. Patients were assessed using clinical scoring systems at baseline, 6 months, 1 year, and 4 years post-surgery.
No major complications were reported during the follow-up period. Significant improvements were observed in the Lysholm knee score, WOMAC score, and VAS pain score at the 4-year follow-up. However, the range of motion improved significantly only up to 12 months, with no further improvement at 4 years.
Around one-third of patients were considered treatment failures due to the need for secondary surgery, further injection therapy, or persistent symptoms. Factors such as age, severity of cartilage defects, BMI, concomitant procedures, and stem cell number from injected MFAT did not significantly correlate with the results.
In conclusion, MFAT intra-articular injection is a safe procedure with positive improvements up to 4-year follow-up in patients with early knee OA, suggesting its potential as a minimally invasive treatment with durable benefits.
ACCESS HERE: https://doi.org/10.1007/s00402-023-05143-y
Intra-articular injection of bone marrow aspirate concentrate (mesenchymal stem cells) in KL grade III and IV knee osteoarthritis: 4 year results of 37 knees
Scientific Reports // LOE: ll
More 4-year follow up data!
This prospective study aimed to investigate the mid-term outcomes of BMAC injections in patients with severe knee osteoarthritis. BMAC was obtained from the iliac crest and injected into the patients' osteoarthritic knees. A total of 37 participants were followed up for 4 years, and their WOMAC, IKDC, SF 36, and walking distance were measured.
Significant improvements in IKDC and WOMAC scores were observed from the second year onwards. Specifically, IKDC increased significantly from 56 ± 12 to 73 ± 13, and WOMAC decreased significantly from 40 ± 23 to 18 ± 18. Remarkably, out of the 37 knees treated, 35 showed improvement in IKDC and WOMAC scores from the first to the last follow-up, and no prostheses had to be implanted.
In conclusion, this study, the first of its kind with a 4-year follow-up, demonstrates that BMAC injections provide significant improvements in IKDC and WOMAC scores and walking distance in patients with severe knee osteoarthritis.
ACCESS HERE: https://doi.org/10.1038/s41598-024-51410-2
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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