Tuesday, February 21, 2012

Exercise Bike Intervals: The Fountain of Youth?

For years now, I have been preaching to my patients about why it is important to ride an exercise bike 30 minutes three times a week to improve their knee function.  It does help strengthen their leg muscles especially the quadriceps, hamstring and gluteal muscles if done consistently.  These are patients with all types of knee issues from meniscus tears to advanced knee osteoarthritis.
See a video of an exercise bike program.

Recent research also suggests that short intense intervals on a bike of one minute with a one minute recovery can significantly improve cardiovascular fitness and also lower blood sugar in patients with Type 2 Diabetes.  Below is an excerpt from a recently published NY Times article about the subject:

"Several years ago, the McMasters scientists did test a punishing workout, known as high-intensity interval training, or HIIT, that involved 30 seconds of all-out effort at 100 percent of a person’s maximum heart rate. After six weeks, these lacerating HIIT sessions produced similar physiological changesin the leg muscles of young men as multiple, hour-long sessions per week of steady cycling, even though the HIIT workouts involved about 90 percent less exercise time.
Recognizing, however, that few of us willingly can or will practice such straining all-out effort, the researchers also developed a gentler but still chronologically abbreviated form of HIIT. This modified routine involved one minute of strenuous effort, at about 90 percent of a person’s maximum heart rate (which most of us can estimate, very roughly, by subtracting our age from 220), followed by one minute of easy recovery. The effort and recovery are repeated 10 times, for a total of 20 minutes."  Read the full article here.  

I think the point is clear.  Almost anyone can begin with one minute intervals.  The data suggests that if you can build on that, your heart and blood sugar will improve in addition to strengthening your knees.  Not a bad suggestion for all of us.
Total Tendon

Saturday, February 11, 2012

Platelet Rich Plasma Effective in the Treatment Elbow Ligament Injuries

Ulnar collateral ligament (UCL) injuries of the elbow occur most commonly in throwing athletes such as baseball players.  There is no perfect answer for patients who partially tear the ligament.  Full thickness tears are typically repaired via so called "Tommy John Surgery".  At the American Academy of Orthopedic Surgery Meeting this week, data was presented suggesting platelet rich plasma has value in the treatment of partial UCL tears.

Dr. Scott Crow of the Kerlan-Jobe Clinic in Los Angeles studied the use of PRP for elbow ligament injuries.  Here is part of his report:

"The researchers followed 17 athletes with a partial UCL tear. All patients had failed conservative treatment, including rest and physical therapy. Baseline questionnaires, including the Kerlan-Jobe Shoulder and Elbow Score (KJOC Score) and Disability of the Arm, Shoulder, and Hand Score (DASH Score) were completed for each patient prior to the PRP injection. Each patient underwent a single PRP injection at the ulnar collateral ligament under ultrasound guidance.
At an average follow-up of 18 weeks (range 12-46 weeks), 16 of 17 athletes had returned to play. The average time to return to play was 10 weeks (range 8-12 weeks). The average KJOC Score improved from 47 to 93, p=.0001. The average DASH Score improved from 24 to 3, p=.003. The Sports Module of the DASH questionnaire improved from 74 to 6, p=.0001.
"There is little information in the literature regarding non-surgical treatment of UCL tears. Our results show that PRP may be an option to return players to the field without having to place them under the knife," said Crow."
This represents the first presented data on the topic of using platelet rich plasma for elbow ligament injuries.  The data supports further investigation and design of randomized trials to confirm these findings.

Thursday, February 09, 2012

Kobe Bryant Orthokine Treatment Explained

Kobe Bryant (LA Lakers) is averaging 29 points per game in his 15th season in the NBA.  Is it because of a blood derived treatment he had done on his knee?  Other elite athletes such as Alex Rodriguez (NY Yankees) and Fred Couples (PGA Golfer)  have been treated with Orthokine in Germany.  But what is Orthokine?  That is a question that needs to be answered.

Orthokine is a form of autologous conditioned serum (ACS) that contains a high concentration of a molecule called IL-1 RA.  This stands for interleukin-1 receptor antagonist (IL-1 RA).  Interleukin-1 (IL-1) is an important mediator of inflammation and tissue damage.  Balancing IL-1 with IL-1 RA is important.  Read more about IL-1/IL-1 RA

Orthokine to the best of my knowledge is only available in Germany and has mainly been used to treat knee osteoarthritis.  A study of 376 patients was done comparing Orthokine (ACS) with hyaluronic acid (HA) and saline injections for knee osteoarthritis.  The "effects of ACS were significantly superior to those of HA and saline for all outcome measures and time points."  See Abstract of Article

From the available evidence, it appears as though this is a reasonable treatment.  I do not, however, know many of the details.  This treatment is not available in the United States.  It is produced by incubating a patient's blood in a sterile container with beads over a period of 6-8 hours or more.  The IL-1 RA and other growth factors are concentrated and injected back into the patient.

This is different than platelet rich plasma (PRP) in that PRP is made at the point of care and can be delivered back to the patient within 15-20 minutes.  No incubation period is needed.  

I will try to learn more about Orthokine and report back.  Please post any comments that may contribute to the conversation and help us all better understand the potential value of this approach.

Allan Mishra, MD


Tuesday, February 07, 2012

Platelet Rich Plasma beats Cortisone for Plantar Fasciitis

In a paper presented today at the American Academy of Orthopedic Surgery Meeting in San Francisco, platelet rich plasma was found to be a significantly better treatment for plantar fasciitis when compared to the standard treatment of cortisone.  See the details outlined below in the abstract presented by Dr. Monto. 

Raymond R. Monto
, MD, Nantucket, Massachusetts, United States

Chronic plantar fasciitis is a common but sometimes difficult condition to successfully treat. Platelet rich plasma (PRP), a concentrated bioactive component of autologous blood that is rich in cytokines and other growth factors, was compared with cortisone injection in the treatment of severe cases of plantar fasciitis resistant to traditional non-operative paradigms.
Thirty-six patients (16 males, 20 females) with severe chronic plantar fasciitis who had failed traditional non-operative treatment (rest, heel lifts, PT, NSAIDS, cam walker immobilization, night splinting, local modalities) were randomized into two study groups and evaluated prospectively. All patients had pre-treatment MRI and ultrasound studies consistent with plantar fasciitis. Group 1 was treated with a single ultrasound-guided injection of 40 mg methylprednisolone at the injury site and Group 2 was treated with a single ultrasound-guided injection of un-buffered autologous PRP at the injury site. All patients were then immobilized fully weight bearing in a cam walker for two weeks, started on eccentric home exercises and then allowed to return to normal activities as tolerated and without support.
Group 1 had an average age of 59 (24-74) and had failed 5.4 months (4-24) of standard non-operative management and had pre-treatment AOFAS scores of 52 (24-60). The PRP group had an average age of 51 (21-67) and had failed 5.7 months (4-26) of standard non-operative management and had pre-treatment AOFAS scores of 37 (30-56). Post-treatment AOFAS scores in Group 1 initially improved to 81 (60-90) at three months but decreased to 74 (56-85) at six months and dropped further to 58 (45-77) at 12 months follow up. Post-treatment AOFAS scores in Group 2 improved to 95 (84-90) at three months and remained excellent at 94 (87-100) at six months and stayed at 94 (86-100) at 12 months follow up (CI 95% P=0.001). No patients were lost to follow up.
This study suggests that platelet rich plasma injection is significantly more effective and durable than cortisone injection for the treatment of severe chronic plantar fasciitis refractory to traditional non-operative management.

Total Tendon

Sunday, February 05, 2012

AAOS Platelet Rich Plasma Symposium

The American Academy of Orthopaedic Surgeons (AAOS) will be holding its annual meeting this week in San Francisco.  The AAOS is sponsoring a symposium on Platelet Rich Plasma on Wednesday Feb. 8th at 10.30 am PST.  This will feature talks about the use of PRP in the office or operating room for achilles tendonitis, rotator cuff tears, tennis elbow, ligament injuries, and knee osteoarthritis among others.  Leading experts will debate its value.

I will be sending out live updates via my twitter account:  @BloodCure
Follow if you would like to view them in real time.  

This symposium will present some of the latest research on the topic of PRP for musculoskeletal injuries and disorders.

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