Monday, February 18, 2013

Platelet Rich Plasma better than Shock Wave for Jumpers' Knee

Jumpers' knee also known as patellar tendinitis is a common problem for basketball and volleyball players among other athletes.  Patients treated with platelet-rich plasma for this condition when compared to shock wave treatment improved more at six and 12 months after treatment.  See abstract below.

This paper adds to the mounting data suggesting PRP is a valuable treatment for chronic tendon related problems such as Jumpers' knee.

MRI of Patellar Tendinopathy
Also Known as Jumpers' Knee

 2013 Feb 13. [Epub ahead of print]

Platelet-Rich Plasma Versus Focused Shock Waves in the Treatment of Jumper's Knee in Athletes.


Physical Medicine and Rehabilitation Unit, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy.


BACKGROUND:Tendinopathies represent a serious challenge for orthopaedic surgeons involved in treatment of athletes. PURPOSE:To compare the effectiveness and safety of platelet-rich plasma (PRP) injections and focused extracorporeal shock wave therapy (ESWT) in athletes with jumper's knee. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:Forty-six consecutive athletes with jumper's knee were selected for this study and randomized into 2 treatment groups: 2 autologous PRP injections over 2 weeks under ultrasound guidance (PRP group; n = 23), and 3 sessions of focused extracorporeal shock wave therapy (2.400 impulses at 0.17-0.25 mJ/mm(2) per session) (ESWT group; n = 23). The outcome measures were Victorian Institute of Sports Assessment-Patella (VISA-P) questionnaire, pain visual analog scale (VAS), and modified Blazina scale. A reviewer who was blinded as to the group allocation of participants performed outcome assessments before treatment and at 2, 6, and 12 months after treatment. Nonparametric tests were used for within-group (Friedman/Wilcoxon test) and between-group (Kruskal-Wallis/Fisher test) testing, and the significance level was set at .05. RESULTS:The 2 groups were homogeneous in terms of age, sex, level of sports participation, and pretreatment clinical status. Patients in both groups showed statistically significant improvement of symptoms at all follow-up assessments. The VISA-P, VAS, and modified Blazina scale scores showed no significant differences between groups at 2-month follow-up (P = .635, .360, and .339, respectively). The PRP group showed significantly better improvement than the ESWT group in VISA-P, VAS scores at 6- and 12-month follow-up, and modified Blazina scale score at 12-month follow-up (P < .05 for all). CONCLUSION:Therapeutic injections of PRP lead to better midterm clinical results compared with focused ESWT in the treatment of jumper's knee in athletes.

Thursday, February 14, 2013

Stem Cells from the Rotator Cuff and Biceps Tendon

In a landmark study, Dr. Pietro Randelli and his colleagues found a population of cells within the rotator cuff and biceps tendon with stem cell like "characteristics (ie, they were self-renewing in vitro, clonogenic, and multipotent), as they could be induced to differentiate into different cell types-namely, osteoblasts, adipocytes, and skeletal 
muscle cells."

The full implications of this paper are difficult to predict but this work could enable entirely new approaches to tendon repair within and outside of the shoulder.  The authors should be congratulated on this truly important work.  See the full abstract below for details.

Total Tendon

 2013 Feb 7. [Epub ahead of print]

Isolation and Characterization of 2 New Human Rotator Cuff and Long Head of Biceps Tendon Cells Possessing Stem Cell-Like Self-Renewal and Multipotential Differentiation Capacity.

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IRCCS Policlinico San Donato, San Donato Milanese, Italy.


BACKGROUND:Stem cell therapy is expected to offer new alternatives to the traditional therapies of rotator cuff tendon tears. In particular, resident, tissue-specific, adult stem cells seem to have a higher regenerative potential for the tissue where they reside. HYPOTHESIS:Rotator cuff tendon and long head of the biceps tendon possess a resident stem cell population that, when properly stimulated, may be induced to proliferate, thus being potentially usable for tendon regeneration. STUDY DESIGN:Controlled laboratory study. METHODS:Human tendon samples from the supraspinatus and the long head of the biceps were collected during rotator cuff tendon surgeries from 26 patients, washed with phosphate-buffered saline, cut into small pieces, and digested with collagenase type I and dispase. After centrifugation, cell pellets were resuspended in appropriate culture medium and plated. Adherent cells were cultured, phenotypically characterized, and then compared with human bone marrow stromal cells (BMSCs), as an example of adult stem cells, and human dermal fibroblasts, as normal proliferating cells with no stem cell properties. RESULTS:Two new adult stem cell populations from the supraspinatus and long head of the biceps tendons were isolated, characterized, and cultured in vitro. Cells showed adult stem cell characteristics (ie, they were self-renewing in vitro, clonogenic, and multipotent), as they could be induced to differentiate into different cell types-namely, osteoblasts, adipocytes, and skeletal muscle cells. CONCLUSION:This work demonstrated that human rotator cuff tendon stem cells and human long head of the biceps tendon stem cells can be isolated and possess a high regenerative potential, which is comparable with that of BMSCs. Moreover, comparative analysis of the sphingolipid pattern of isolated cells with that of BMSCs and fibroblasts revealed the possibility of using this class of lipids as new possible markers of the cell differentiation status. CLINICAL RELEVANCE:Rotator cuff and long head of the biceps tendons contain a stem cell population that can proliferate in vitro and could constitute an easily accessible stem cell source to develop novel therapies for tendon regeneration.

Tuesday, February 05, 2013

Steroid Shots NOT helpful for Tennis Elbow

For years now, physicians of all types have recommended steroid injections for tennis elbow.  There has been some debate about the value of these injections.  It is time to declare there is no significant value and they may actually be harmful.  A new study published today by the Journal of the American Medical Association (JAMA) evaluated 165 patients in a prospective, randomized fashion.  In this study, patients were given a corticosteroid injection or a placebo injection.  Physical therapy was also added.  Reuters Health ran a story about the study today.  Here are some excerpts:  

(Reuters Health) - "Getting a cortisone injection won't cure tennis elbow any better than a drug-free saline shot, according to a new study - and it might actually slow recovery."

"Among those who'd received a cortisone shot, 83 percent reported they had completely recovered from tennis elbow by one year. That compared to 96 percent of those who'd received a placebo injection, according to findings published Tuesday in the Journal of the American Medical Association."

"This evidence does not support the clinical practice of using corticosteroid injection to facilitate active rehabilitation," the study team wrote."

Read the full article by Genevra Pittman from Reuters.  

It is clear form published peer reviewed data that cortisone injections have little or no value in the treatment of tennis elbow.  Data suggests a platelet rich plasma injection is significantly better option than cortisone.   Or, try a simple stretching and strengthening program.  Always also consult with a physician also to make sure you have a proper diagnosis.

Simple Tennis Elbow Stretches

Simple Tennis Elbow Strengthening Exercises


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