Wednesday, November 26, 2008

Platelet Rich Plasma helps Treat Achilles Tendons

The published and presented data supporting the use of buffered platelet rich plasma continues to grow. PRP has now been shown in a small study to help treat chronic achilles tendonitis (tendinosis).

AM (Total Tendon, ApexPRP)

Guelfi et al recently presented a series of 16 cases of non-insertional achilles tendonitis at a recent meeting in Brazil. They used unactivated, buffered platelet rich plasma prepared using the Biomet Recover System, also known as the GPS. Significant improvement was found in all 16 of their patients via imaging. They also reported the patients returning to sports at six months with a high degree of satisfaction.

MRI Prior to PRP

4 months after PRP
"International Federation of Foot and Ankle Societies", , Third Triennial Scientific Meeting, Costa do Sauipe, Bahia, Brazil September 18-20, 2008. (The case shown is from AM)

Sunday, November 02, 2008

Growth Factors in Shoulder Surgery

In the article outlined below, Dr. Randelli and his colleagues have confirmed that valuable growth factors are released when performing an arthroscopic acromioplasty. This is a landmark paper that will be cited many times as we try to understand how to use platelet rich plasma and other biologic treatments. His work for the first time has confirmed that the mechanical removal of an acromial spur has biologic consequences. Excellent information.
Total Tendon

Release of growth factors after arthroscopic acromioplasty.

It has recently been postulated that a variety of growth factors may be released from cancellous bone after an acromioplasty. The aim of this study was to demonstrate the presence of growth factors in the subacromial space after acromioplasty. Between October 2006 and March 2007, 23 patients underwent arthroscopic acromioplasty. A sample of at least 3 ml of fluid from the shoulder was obtained 15 min after the end of the procedure. At the same time another sample of 3 ml of the patient's venous blood was obtained as a control. The concentrations of growth factors in the fluids collected were determined using enzyme-linked immunosorbent assay (ELISA). The growth factors assayed were platelet-derived growth factor-AB (PDGF-AB), basic fibroblast growth factor basic (bFGF) and transforming growth factor beta 1 (TGF-beta1). The concentrations of TGF-beta1 (p = 0.0001), PDGF-AB (p = 0.02), and bFGF (p <>

PRP promotes Cell Proliferation

Below is still more basic science evidence to suggest platelet rich plasma is helpful for wound healing and tissue engineering.
AM (Total Tendon)

Plast Reconstr Surg. 2008 Nov;122(5):1352-60.

Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts.

Department of Plastic and Reconstructive Surgery, Kansai Medical University, Osaka, Japan.

BACKGROUND: This study evaluated changes in platelet-derived growth factor (PDGF)-AB and transforming growth factor (TGF)-beta1 release from platelets by platelet-rich plasma activation, and the proliferation potential of activated platelet-rich plasma and platelet-poor plasma on human adipose-derived stem cells and human dermal fibroblasts. METHODS: Platelet-rich plasma was prepared using a double-spin method, with the number of platelets counted in each preparation stage. Platelet-rich and platelet-poor plasma were activated with autologous thrombin and calcium chloride, and levels of platelet-released PDGF-AB and TGF-beta1 were determined by enzyme-linked immunosorbent assay. Cells were cultured for 1, 4, or 7 days in serum-free Dulbecco's Modified Eagle Medium supplemented with 5% whole blood plasma, nonactivated platelet-rich plasma, nonactivated platelet-poor plasma, activated platelet-rich plasma, or activated platelet-poor plasma. In parallel, these cells were cultured for 1, 4, or 7 days in serum-free Dulbecco's Modified Eagle Medium supplemented with 1%, 5%, 10%, or 20% activated platelet-rich plasma. The cultured human adipose-derived stem cells and human dermal fibroblasts were assayed for proliferation. RESULTS: Platelet-rich plasma contained approximately 7.9 times as many platelets as whole blood, and its activation was associated with the release of large amounts of PDGF-AB and TGF-beta1. Adding activated platelet-rich or platelet-poor plasma significantly promoted the proliferation of human adipose-derived stem cells and human dermal fibroblasts. Adding 5% activated platelet-rich plasma to the medium maximally promoted cell proliferation, but activated platelet-rich plasma at 20% did not promote it. CONCLUSIONS: Platelet-rich plasma can enhance the proliferation of human adipose-derived stem cells and human dermal fibroblasts. These results support clinical platelet-rich plasma application for cell-based, soft-tissue engineering and wound healing.

Saturday, November 01, 2008

Best Treatment for Tennis Elbow?

We are polling people to figure out the best treatment for a patient with 3 months of tennis elbow pain (lateral epicondylitis). The patient is a healthy 42 year old female who plays 2-3 hours per week and can no longer participate. Her pain now occurs even with activities of daily living such as driving. Please vote in the poll on this blog.

Comment as you wish as well.

AM (Total Tendon)
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