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Prolotherapy. Phys Med Rehabil Clin N Am 2023; 34:165-180. [DOI: 10.1016/j.pmr.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Moon C, Groman R, Jasak R, Sereiko TJ, Brunner M, Weinstein S. PM&R BOLD: A closer look at the American Academy of Physical Medicine and Rehabilitation's strategic initiative to envision - and effectuate - the future of musculoskeletal care. PM R 2021; 13:781-789. [PMID: 33932321 DOI: 10.1002/pmrj.12625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/26/2021] [Accepted: 03/26/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Cindy Moon
- Hart Health Strategies, Washington, DC, USA
| | | | | | - Tracy J Sereiko
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | - Megan Brunner
- American Academy of Physical Medicine and Rehabilitation, Rosemont, Illinois, USA
| | - Stuart Weinstein
- Sports Medicine Center, Harborview Medical Center, University of Washington, Seattle, Washington, USA
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Robinson DM, Eng C, Makovitch S, Rothenberg JB, DeLuca S, Douglas S, Civitarese D, Borg-Stein J. Non-operative orthobiologic use for rotator cuff disorders and glenohumeral osteoarthritis: A systematic review. J Back Musculoskelet Rehabil 2021; 34:17-32. [PMID: 33361581 DOI: 10.3233/bmr-201844] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Shoulder pain from rotator cuff pathology and glenohumeral osteoarthritis is a common entity encountered in musculoskeletal practices. Orthobiologic agents are being increasingly used as a treatment option and understanding their safety and efficacy is necessary. OBJECTIVE To systematically evaluate the available evidence for orthobiologic use in rotator cuff and glenohumeral pathology. METHODS A systematic review was undertaken following PRISMA guidelines. Randomized clinical trials (RCTs) and prospective cohort studies evaluating non-operative treatment with prolotherapy, platelet-rich plasma (PRP), or medicinal signaling cells (MSCs) for rotator cuff pathology and glenohumeral osteoarthritis were included. Bias risk assessments used were the Cochrane tool and Newcastle-Ottawa score. RESULTS The search yielded 852 potential articles, of which 20 met the inclusion criteria with a breakdown of 5 prolotherapy, 13 PRP, and 2 MSC. Sixteen studies were RCTs and 4 were cohort studies. Six studies were deemed "low risk of bias or good quality". Efficacy results were mixed, and no serious adverse events were reported from orthobiologic treatment. CONCLUSIONS Orthobiologics offer a relatively safe management option with inconclusive evidence for or against its use for rotator cuff pathology. No studies on glenohumeral osteoarthritis met the inclusion criteria. Adoption of standardized preparation reporting and consistent use of functional outcome measures is imperative for future studies to consider.
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Affiliation(s)
- David M Robinson
- Spaulding Rehabilitation Hospital/Harvard Medical School, Department of Physical Medicine and Rehabilitation, Charlestown, MA, USA
| | - Christine Eng
- Spaulding Rehabilitation Hospital/Harvard Medical School, Department of Physical Medicine and Rehabilitation, Charlestown, MA, USA.,Spaulding Rehabilitation Hospital/Harvard Medical School, Department of Physical Medicine and Rehabilitation, Spaulding Wellesley Outpatient Care Center, Wellesley, MA, USA
| | - Steven Makovitch
- Spaulding Rehabilitation Hospital/Harvard Medical School, Department of Physical Medicine and Rehabilitation, Charlestown, MA, USA
| | - Joshua B Rothenberg
- Boca Raton Regional Hospital, Regenerative Medicine and Orthopedics Biologic Department, Boca Raton, FL, USA
| | - Stephanie DeLuca
- Spaulding Rehabilitation Hospital/Harvard Medical School, Department of Physical Medicine and Rehabilitation, Charlestown, MA, USA
| | - Stephanie Douglas
- Spaulding Rehabilitation Hospital/Harvard Medical School, Department of Physical Medicine and Rehabilitation, Charlestown, MA, USA
| | - David Civitarese
- Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, FL, USA
| | - Joanne Borg-Stein
- Spaulding Rehabilitation Hospital/Harvard Medical School, Department of Physical Medicine and Rehabilitation, Charlestown, MA, USA.,Spaulding Rehabilitation Hospital/Harvard Medical School, Department of Physical Medicine and Rehabilitation, Spaulding Wellesley Outpatient Care Center, Wellesley, MA, USA
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Tenforde A, Robinson D, Borg‐Stein J, Borgstrom H, Singh JR. Extracorporeal Shockwave Therapy Versus Platelet‐rich Plasma for Achilles Tendinopathy. PM R 2020; 12:1169-1176. [DOI: 10.1002/pmrj.12498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 09/21/2020] [Indexed: 01/14/2023]
Affiliation(s)
- Adam Tenforde
- Department of Physical Medicine and Rehabilitation Harvard Medical School Cambridge MA
- Spaulding National Running Center, Spaulding Hospital Spaulding Rehabilitation Hospital Charlestown MA
| | - David Robinson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital Charlestown MA
| | - Joanne Borg‐Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital Charlestown MA
| | - Haylee Borgstrom
- Department of Physical Medicine and Rehabilitation, Harvard Medical School Spaulding Rehabilitation Hospital Charlestown MA
| | - Jaspal Ricky Singh
- Weill Cornell Center for Comprehensive Spine Care Weill Cornell Medicine Department of Rehabilitation Medicine New York NY
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Abstract
Biologics are a growing field that has shown immense promise for the treatment of musculoskeletal conditions both in orthopedic sports medicine and interventional pain management. These procedures utilize injection of supraphysiologic levels of platelets and growth factors to invoke the body's own inflammatory cascade to augment the healing of many bony and soft tissue conditions. While many patients improve with conservative care, there is a need to address the gap between those that improve with rehabilitation alone and those who ultimately require operative management. Orthobiologic procedures have the potential to fill this void. The purpose of this review is to summarize the basic science, evidence for use, and post-injection rehabilitation concepts of platelet-rich plasma (PRP) and mesenchymal stromal cells (MSCs) as they pertain to joints, tendons, ligaments, and the spine.
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Affiliation(s)
- Robert L Bowers
- Department of Physical Medicine and Rehabilitation, Emory University School of Medicine, Atlanta, GA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA.
| | - Wesley D Troyer
- Department of Physical Medicine and Rehabilitation, Emory University School of Medicine, Atlanta, GA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
| | - Rudolph A Mason
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA; Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA
| | - Kenneth R Mautner
- Department of Physical Medicine and Rehabilitation, Emory University School of Medicine, Atlanta, GA; Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA
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Auriemma MJ, Tenforde AS, Harris A, McInnis KC. Platelet-rich plasma for treatment of chronic proximal hamstring tendinopathy. Regen Med 2020; 15:1509-1518. [PMID: 32419631 DOI: 10.2217/rme-2019-0105] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Aim: To determine whether platelet-rich plasma (PRP) can successfully treat symptoms associated with proximal hamstring tendinopathy. Materials & methods: Charts were retrospectively reviewed of patients with a diagnosis of chronic proximal hamstring tendinopathy who underwent an ultrasound-guided leukocyte-rich PRP injection to assess reported outcomes at baseline and final follow-up post-intervention. Results: In 22 patients with a mean age of 48.7 years and mean symptom duration of 26.5 months, mean Numeric Pain Rating Scale and Victorian Institute of Sport Assessment Scale for Proximal Hamstring Tendinopathy subscores demonstrated statistically significant improvements (p < 0.05) at a mean of 7.91 months follow-up. Sixty-eight percent of patients demonstrated ≥50% reduction of pain. Conclusion: Pain and functional outcomes improved following injection of PRP.
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Affiliation(s)
- Michael J Auriemma
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.,Spaulding Rehabilitation Hospital, 300 1st Ave, Charlestown, MA 02129, USA
| | - Adam S Tenforde
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.,Spaulding Rehabilitation Hospital, 300 1st Ave, Charlestown, MA 02129, USA
| | - Adam Harris
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.,Spaulding Rehabilitation Hospital, 300 1st Ave, Charlestown, MA 02129, USA
| | - Kelly C McInnis
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.,Spaulding Rehabilitation Hospital, 300 1st Ave, Charlestown, MA 02129, USA.,Department of Sports Medicine, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, USA
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Desai MJ, Mansfield JT, Robinson DM, Miller BC, Borg-Stein J. Regenerative Medicine for Axial and Radicular Spine-Related Pain: A Narrative Review. Pain Pract 2020; 20:437-453. [PMID: 31869517 DOI: 10.1111/papr.12868] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/03/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Regenerative injection-based therapy has established itself as a therapeutic option for the management of a variety of painful musculoskeletal conditions. The aim of this work was to review the current literature regarding regenerative injection therapy for axial/radicular spine pain. METHODS A comprehensive literature review was conducted on the use of regenerative medicine for axial/radicular spine pain. Eligible articles analyzed the therapeutic injection effects of platelet-rich plasma (PRP), prolotherapy, or mesenchymal signaling cells (MSCs) via intradiscal, facet joint, epidural, or sacroiliac joint delivery. RESULTS Regarding intradiscal PRP, there are level I/IV studies supporting its use. Regarding intradiscal prolotherapy, there are level III to IV studies supporting its use. Regarding intradiscal MSCs, there are level I/IV studies supporting its use with the exception of one level IV study that found no significant improvement at 12 months. Regarding facet joint injections with PRP, there are level I/IV studies supporting its use. Regarding facet joint injections with prolotherapy, there are level IV studies supporting its use, though the one level I study did not demonstrate any statistical significance supporting its use. Regarding epidural injections with PRP, there are level I/IV studies supporting its use. Regarding epidural injections with prolotherapy, there are level IV studies supporting its use, though the one level I study did not demonstrate statistical significance beyond 48 hours. Regarding sacroiliac joint injections with PRP, there are level I/IV studies supporting its use. Regarding sacroiliac joint injections with prolotherapy, there are level I/III studies supporting its use. CONCLUSIONS Currently, there are level I studies to support the use of PRP and MSC injections for discogenic pain; facet joint injections with PRP; epidural injections of autologous conditioned serum and epidural prolotherapy; and PRP and prolotherapy for sacroiliac joint pain. One level I study showed that facet joint prolotherapy has no significant benefit. Notably, no intervention has multiple published level I studies.
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Affiliation(s)
- Mehul J Desai
- International Spine, Pain & Performance Center, Washington, DC, U.S.A.,George Washington University, Washington, DC, U.S.A.,Division of Pain Medicine, Virginia Hospital Center, Arlington, Virginia, U.S.A
| | - John Taylor Mansfield
- Department of Physical Medicine and Rehabilitation, MedStar Georgetown University Hospital, Washington, DC, U.S.A
| | - David M Robinson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, U.S.A
| | - Benjamin C Miller
- Department of Physical Medicine and Rehabilitation, MedStar Georgetown University Hospital, Washington, DC, U.S.A
| | - Joanne Borg-Stein
- Division of Sports and Musculoskeletal Rehabilitation, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts, U.S.A
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