Monday, November 30, 2009

PRP and Ultrasound

Using ultrasound to guide platelet rich plasma injections is becoming more popular. For some indications it may be crucial. Importantly, ultrasound may an excellent way to test the value of platelet rich plasma for tendon related injuries and disorders. In the following study, Bosch et al did just that. The researchers confirmed the value of ultrasound and also found PRP treated cases had better tissue alignment.

Total Tendon

"The effectiveness of new therapies to treat tendon injuries is difficult to determine and is often based on semi-quantitative methods, such as grey level analysis of ultrasonographic images or subjective pain scores. The alternatives are costly and long-lasting end-stage studies using experimental animals. In this study, a method of ultrasonographic tissue characterisation (UTC), using mathematical analysis of contiguous transverse ultrasonographic images, was used for intra-vital monitoring of the healing trajectory of standardised tendon lesions treated with platelet rich plasma (PRP) or placebo. Using UTC it was possible to detect significant differences between the groups in the various phases of repair. At end stage, over 80% of pixels showed correct alignment in the PRP group, compared with just over 60% in the placebo group (P<0.05). UTC also showed significant differences in the course of the healing process between PRP treated and placebo treated animals throughout the experiment. It was concluded that computerised analysis of ultrasonographic images is an excellent tool for objective longitudinal monitoring of the effects of treatments for superficial digital flexor tendon lesions in horses."


Thursday, November 26, 2009

PRP Enhances Tendon Vascularity

Platelet rich plasma is now being used worldwide for tendon related injuries and disorders. Increased vascularity is one of the proposed mechanism of action for PRP. In the study outlined below, this hypothesis is supported in an achilles tendon injury model.

The poor vascularity of tendons is a major factor in their limited healing capacity. The aim of this study was to assess the effect of Platelet Rich Plasma (PRP) on angiogenesis during tendon healing. MATERIALS AND METHODS: Forty-eight skeletally mature New Zealand White rabbits were used. The Achilles tendon was transected transversely and 0.5 ml of PRP was injected into the tendon mass on each side of the incision on both limbs. The injection in the control group consisted of saline. Six animals from each group (12 tendons each) were sacrificed after 1, 2, 3, and 4 weeks following treatment. Three sections from each Achilles were stained with hematoxylinosin for microscopic examination. Further three sections were immunostained with a monoclonal antibody against CD31 (Daco Co), followed by image analysis to count new vessel numbers and statistical analysis was performed. RESULTS: There was significantly more angiogenesis in the PRP group compared to the control group during the first two weeks of the healing process, i.e., inflammatory and proliferative phase (p <> Lyras et al.


Saturday, November 21, 2009

Platelet Rich Plasma and ACL Surgery

The use of Platelet Rich Plasma to augment anterior cruciate ligament reconstruction has been much discussed but not well studied until now. In a prospective randomized trial, Nin et al studied allograft ACL surgery with and without PRP.

"We prospectively randomized 100 patients undergoing arthroscopic patellar tendon allograft ACL reconstruction to a group in whom platelet-enriched gel was used (n = 50) and a non-gel group (n = 50). The platelet concentration was 837 x 10(3)/mm(3), and the gel was introduced inside the graft and the tibial tunnel. The use of PDGF, on the graft and inside the tibial tunnel, in patients treated with bone-patellar tendon-bone allografts has no discernable clinical or biomechanical effect at 2 years' follow-up." Read Full Abstract

This is a good example of where PRP may NOT be helpful.

Total Tendon

DNA Vaccines

DNA vaccines arose out of failed genetic engineering experiments. In this so called third generation vaccine, a piece of DNA is designed to have a cell express a specific surface antigen. It is then injected and the immune systems responds. DNA vaccines are under development for a variety of diseases including the H1N1 virus also known as the swine flu.

Total Tendon

Wednesday, November 18, 2009

Stem Cells Improve Heart Function

Study Shows Benefits of Adult Stem Cells for Heart Disease

"In the 12-month Phase II, double-blind trial, subjects' own purified stem cells, called CD34+ cells, were injected into their hearts in an effort to spur the growth of small blood vessels that make up the microcirculation of the heart muscle....

The largest national stem cell study for heart disease showed the first evidence that transplanting a potent form of adult stem cells into the heart muscle of subjects with severe angina results in less pain and an improved ability to walk."

Read Full Article.

This is well done and interesting investigation into how your own body's cells can improve function in tissue that was once thought not to be able to regenerate. As we investigate deeper into stem cells and other treatments, we are likely to continue to challenge many long held beliefs about human physiology.

Total Tendon

Monday, November 16, 2009

Umblical Cord Stem Cells Accelerate Liver DIsease

Researchers were in search of a way to regenerate liver cells damaged by cirrhosis. The idea was to use stem cells from cord blood as a treatment. The treatment, however, resulted in increased liver AND kidney damage. We clearly need to better understand such treatment before moving forward in humans. Fortunately, this study was done in rats.

Link to full story.

Total Tendon

Friday, November 13, 2009

Stem Cell Types

There are three basic types of stem cells. Embryonic stem cells as the name implies come from embryos and have ethical issues surrounding them. Adult stem cells can be purified from a variety of sources including bone marrow and fat. Finally, induced pluripotent stem cells are artificially made from somatic cells such as skin cells. This final type of stem cells is produced by a form of genetic engineering. Viruses are used to insert genes and change the characteristics of the cells.

Embryonic and induced pluripotent stem cells are years away from any real value as treatments because they carry a serious risk of cancer. This has not been well outlined in the press but needs to be discussed. Adult stem cells are used for a variety of treatments already including bone marrow transplants and other indications.

Sunday, November 01, 2009

American Journal of Sports Medicine

The American Journal of Sports Medicine just published a review article about platelet rich plasma.

"PRP contains growth factors and bioactive proteins that influence the healing of tendon, ligament, muscle, and bone. This article examines the basic science of PRP, and it describes the current clinical applications in sports medicine." See abstract

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