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Herber A, Covarrubias O, Daher M, Tung WS, Gianakos AL. Platelet rich plasma therapy versus other modalities for treatment of plantar fasciitis: A systematic review and meta-analysis. Foot Ankle Surg 2024; 30:285-293. [PMID: 38395675 DOI: 10.1016/j.fas.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/04/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Plantar fasciitis (PF) is the most common cause of heel pain in adults. There are numerous non-operative treatments available including platelet rich plasma (PRP) injections. PPR has demonstrated effectiveness for a range of musculoskeletal conditions including plantar fasciitis. PURPOSE/OBJECTIVE To compare the effectiveness of PRP to other conservative treatment options for the management of PF. METHODS A systematic search of PubMed and Google Scholar was performed for randomized control trials (RCT) comparing PRP to other treatment modalities. Studies met inclusion criteria if mean and standard deviations for visual analog scale (VAS) pain scores, plantar fascia thickness (PFT), Foot Function Index (FFI), or American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Score were reported. Mean differences (MD) were used to compare VAS pain, PFT, FFI, and AOFAS between PRP and other treatments. RESULTS Twenty-one RCTs which altogether included 1356 patients were included in the meta-analysis. PRP demonstrated significantly greater improvements in VAS pain scores compared to extracorporeal shock wave therapy (ESWT) (SMD: 0.86; CI: [0.30, 1.41]; p = 0.002), corticosteroid injections (CSI) (SMD: 1.08; CI: [0.05, 2.11]; p = 0.04), and placebo (SMD: 3.42; CI: [2.53, 4.31]; p < 0.00001). In terms of FFI, no significant differences existed among PRP, ESWT, CSI, dextrose prolotherapy (DPT), and meridian trigger points (MTP) in enhancing foot functionality. However, PRP demonstrated a marked advantage over phonophoresis, showing a substantial improvement in FFI scores (SMD: 3.07, 95% CI: 2.34-3.81). PRP did not demonstrate superiority over ESWT, CSI, or MTP for improving PFT, but it was notably more effective than phonophoresis (SMD: 3.18, 95% CI: 2.43-3.94). PRP demonstrated significantly greater improvements in AOFAS scores over CSI (SMD: 3.31, CI: [1.35, 5.27], p = 0.0009) and placebo (SMD: 3.75; CI: [2.81, 4.70]; p < 0.00001). CONCLUSION PRP is more effective than CSI, ESWT, and placebo in reducing VAS and more effective than CSI and placebo in improving AOFAS. PRP did not demonstrate a consistent advantage across all outcome measures, such as PFT and FFI. These findings underscore the complexity of PF treatment and call for a more standardized approach to PRP preparation and outcome measurement. LEVEL OF EVIDENCE Level I Meta-Analysis.
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Affiliation(s)
- Agustin Herber
- Department of Surgery, University of Arizona College of Medicine - Phoenix, Phoenix, AZ 85004, USA.
| | - Oscar Covarrubias
- Department of Orthopedics, Brown University, Providence, RI 02906, USA
| | - Mohammad Daher
- Department of Orthopedics, Brown University, Providence, RI 02906, USA
| | - Wei Shao Tung
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT 06510, USA
| | - Arianna L Gianakos
- Department of Orthopaedics and Rehabilitation, Yale University, New Haven, CT 06510, USA
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Peña-Martínez VM, Acosta-Olivo C, Simental-Mendía LE, Sánchez-García A, Jamialahmadi T, Sahebkar A, Vilchez-Cavazos F, Simental-Mendía M. Effect of corticosteroids over plantar fascia thickness in plantar fasciitis: a systematic review and meta-analysis. PHYSICIAN SPORTSMED 2024; 52:217-228. [PMID: 37293970 DOI: 10.1080/00913847.2023.2223673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 06/03/2023] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Corticosteroid injections have been typically used for the management of plantar fasciitis with apparently good clinical outcomes; however, there is no information of the effect of corticosteroids on the thickness of the plantar fascia which is typically altered in this pathology. We aimed determine whether treatment with corticosteroid injections induces plantar fascia thickness changes in plantar fasciitis. METHODS MEDLINE, Embase, Web of Science, and Scopus databases were searched for randomized controlled trials (RCT) reporting the use of corticosteroid injection to treat plantar fasciitis to July 2022. Studies must have reported plantar fascia thickness measurement. The risk of bias in all studies was assessed with the Cochrane Risk of Bias 2.0 tool. Meta-analysis was conducted using a random-effects model and the generic inverse variance method. RESULTS Data from 17 RCT (including 1109 subjects) were collected. The follow-up period ranged from one to six months. Most studies measured the thickness of the plantar fascia at the insertion into the calcaneus using ultrasound. Pooled analysis revealed that corticosteroid injections had no significant effect on plantar fascia thickness (weighted mean differences [WMD], 0.06 mm [95% CI: -0.17, 0.29]; p = 0.61) or pain relief (WMD, 0.12 cm [95% CI: -0.36, 0.61]; p = 0.62) above active controls. CONCLUSION Corticosteroid injections do not perform better than other common interventions in terms of a decrease of plantar fascia thickness and pain relief for plantar fasciitis.
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Affiliation(s)
- Víctor M Peña-Martínez
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", Monterrey, México
| | - Carlos Acosta-Olivo
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", Monterrey, México
| | | | - Adriana Sánchez-García
- Universidad Autonoma de Nuevo Leon, Endocrinology Division, University Hospital "Dr. José Eleuterio González", Monterrey, México
| | - Tannaz Jamialahmadi
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Félix Vilchez-Cavazos
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", Monterrey, México
| | - Mario Simental-Mendía
- Universidad Autonoma de Nuevo Leon, Orthopedic Trauma Service, University Hospital "Dr. José Eleuterio González", Monterrey, México
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Kumar K, Rao V, Panda A, K G S, Buddhist H. Comparison of Platelet-Rich Plasma and Corticosteroid Injections for Chronic Plantar Fasciitis: A Randomized Controlled Trial. Cureus 2024; 16:e59656. [PMID: 38836136 PMCID: PMC11147740 DOI: 10.7759/cureus.59656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Plantar fasciitis is a common and debilitating foot condition, with varying treatment options and inconsistent outcomes. The objective of this study was to assess and compare the effectiveness of autologous platelet-rich plasma (PRP) injections and corticosteroid injections in treating persistent plantar fasciitis. METHODS In this study, a total of 70 patients suffering from chronic plantar fasciitis were randomly divided into two groups, i.e., one receiving PRP injections (n=35) and the other receiving corticosteroid injections (n=35). The visual analog scale (VAS) was used to assess pain outcomes, while the American Orthopaedic Foot and Ankle Society (AOFAS) score was used to assess functional status. Patients were assessed before the injection and then followed up at 15 days, one month, three months, and six months after the injection. RESULTS The baseline VAS and AOFAS scores were similar between the two groups. However, the PRP group showed significantly greater improvements in VAS and AOFAS scores compared to the corticosteroid group at the one-month, three-month, and six-month follow-ups (p<0.05). The PRP group had a higher proportion of patients with mild or moderate pain and better functional outcomes at later time points. CONCLUSIONS Autologous PRP injections are superior to corticosteroid injections in terms of long-term pain alleviation and functional improvement for patients suffering from chronic plantar fasciitis. Platelet-rich plasma should be regarded as a feasible therapeutic choice for this condition, especially in individuals who have not shown improvement with conservative treatment.
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Affiliation(s)
- Krishan Kumar
- Orthopaedics, Sports Injury Centre, Vardhman Mahavir Medical College (VMMC) & Safdarjung Hospital, New Delhi, IND
| | - Vikas Rao
- Orthopaedics, Sports Injury Centre, Vardhman Mahavir Medical College (VMMC) & Safdarjung Hospital, New Delhi, IND
| | - Amrit Panda
- Orthopaedics, Sports Injury Centre, Vardhman Mahavir Medical College (VMMC) & Safdarjung Hospital, New Delhi, IND
| | - Sathyendra K G
- Orthopaedics, Employees State Insurance-Post Graduate Institute of Medical Sciences and Research (ESI-PGIMSR), New Delhi, IND
| | - Harshvardhan Buddhist
- Orthopaedics, Sports Injury Centre, Vardhman Mahavir Medical College (VMMC) & Safdarjung Hospital, New Delhi, IND
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Lim JJ, Belk JW, Wharton BR, McCarthy TP, McCarty EC, Dragoo JL, Frank RM. Most Orthopaedic Platelet-Rich Plasma Investigations Don't Report Protocols and Composition: An Updated Systematic Review. Arthroscopy 2024:S0749-8063(24)00243-3. [PMID: 38522650 DOI: 10.1016/j.arthro.2024.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/28/2024] [Accepted: 03/12/2024] [Indexed: 03/26/2024]
Abstract
PURPOSE To systematically review the literature to assess the heterogeneity of platelet-rich plasma (PRP) preparation and composition reporting for the treatment of musculoskeletal/orthopaedic pathologies. METHODS A systematic review was performed by searching PubMed, the Cochrane Library, and Embase to identify Level I and Level II studies from 2016 to 2022 that evaluated the use of PRP therapy for musculoskeletal pathologies. The search phrase used was "platelet-rich plasma clinical studies." Studies were assessed based on their reporting of the PRP preparation methods and reporting of PRP composition. RESULTS One hundred twenty-four studies (in 120 articles) met inclusion criteria for analysis. Of these studies, 15 (12.1%) provided comprehensive reporting, including a clear, well-described, and reproducible preparation protocol that future investigators can follow. Thirty-three studies (26.6%) quantitatively reported the final PRP product composition. CONCLUSIONS Among the studies using PRP for the treatment of musculoskeletal/orthopaedic pathologies, less than 20% provided a clear, well-described, and reproducible PRP preparation protocol, and only one-fourth of studies reported on the final PRP product composition. CLINICAL RELEVANCE A diverse current reporting of PRP composition between studies provides a high heterogeneity of the term "PRP," which becomes a limitation for a comparison of studies using PRP.
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Affiliation(s)
- Joseph J Lim
- University of Colorado Boulder, Boulder, Colorado, U.S.A..
| | - John W Belk
- University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | | | - Timothy P McCarthy
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Eric C McCarty
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Jason L Dragoo
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
| | - Rachel M Frank
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, U.S.A
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Ruiz-Hernández IM, Gascó-Adrien J, Buen-Ruiz C, Perelló-Moreno L, Tornero-Prieto C, Barrantes-Delgado G, García-Gutiérrez M, Rapariz-González JM, Tejada-Gavela S. Botulinum toxin A versus platelet rich plasma ultrasound-guided injection in the treatment of plantar fasciitis: A randomised controlled trial. Foot Ankle Surg 2024; 30:117-122. [PMID: 37949704 DOI: 10.1016/j.fas.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/14/2023] [Accepted: 10/13/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP) and botulinum toxin type A (BTX-A) injections have proven effective in clinical trials for plantar fasciitis treatment but have not been directly compared. We aimed to compare clinical outcomes in patients undergoing PRP or BTX-A injections. METHODS We performed a randomised controlled trial (59 patients; 1-year follow-up) to assess efficacy, using pain and functional scales (VAS, AOFAS Hindfoot-scale and FAAM questionnaire) and fascia thickness reduction, in control and single ultrasound-guided BTX-A or PRP injection groups. RESULTS The BTX-A group showed better results at 1-month after treatment. Conversely, the PRP injection was more effective in the long-term, with significant pain reduction and functional improvement. Plantar fascia thickness significantly reduced from months 1 and 3 in the PRP and BTX-A groups, respectively. CONCLUSION PRP and BTX-A injections are effective in patients with plantar fasciitis with BTX-A achieving better short-term pain reduction and PRP better long-term results. LEVEL OF EVIDENCE Level I; Randomised Controlled Trial.
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Affiliation(s)
- Isabel M Ruiz-Hernández
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain; Foot and Ankle Unit (Pieytobillo.es), Hospital Quironsalud Rotger, Calle Santiago Rusiñol, 9, 07012 Palma, Baleares, Spain.
| | - Javier Gascó-Adrien
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain; Foot and Ankle Unit (Pieytobillo.es), Hospital Quironsalud Rotger, Calle Santiago Rusiñol, 9, 07012 Palma, Baleares, Spain
| | - Carmen Buen-Ruiz
- Department of Physical Therapy and Rehabilitation, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - Laura Perelló-Moreno
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - Carmen Tornero-Prieto
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - Gonzalo Barrantes-Delgado
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain; Foot and Ankle Unit (Pieytobillo.es), Hospital Quironsalud Rotger, Calle Santiago Rusiñol, 9, 07012 Palma, Baleares, Spain
| | - Mireia García-Gutiérrez
- Department of Physical Therapy and Rehabilitation, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - J M Rapariz-González
- Department of Orthopaedics and Traumatology, Hospital Universitario Son Llàtzer, Carretera de Manacor, 07198 Palma, Baleares, Spain
| | - S Tejada-Gavela
- Department of Biology, Universitat de les Illes Balears, Cra. de Valldemossa, km 7.5, 07122 Palma, Baleares, Spain
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Bagheri K, Krez A, Anastasio AT, Adams SB. The use of platelet-rich plasma in pathologies of the foot and ankle: A comprehensive review of the recent literature. Foot Ankle Surg 2023; 29:551-559. [PMID: 37516651 DOI: 10.1016/j.fas.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/27/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
Platelet-rich plasma (PRP) is an autologous serum containing higher concentrations of platelets and growth factors above normal blood. The process of obtaining PRP involves the extraction of blood from the patient which is then centrifuged to obtain a concentrated suspension of platelets. PRP continues to evolve as a potential treatment modality with many applications in orthopaedic surgery. The therapeutic components of PRP possess numerous theoretical regenerative properties. The present manuscript outlines how PRP is prepared, noting the tremendous variability between preparation protocols. Given the growing body of evidence examining the use of PRP in pathologies of the foot and ankle, we assess its efficacy as it relates to our field. Specifically, we evaluate the literature in the past five years regarding the role of PRP in treating plantar fasciitis, Achilles tendinopathy, insertional Achilles tendinitis, Achilles tendon ruptures, osteochondral lesions of the talus, hallux rigidus, and ankle osteoarthritis.
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Affiliation(s)
- Kian Bagheri
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA.
| | | | - Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
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Sneed D, Wong C. Platelet-rich plasma injections as a treatment for Achilles tendinopathy and plantar fasciitis in athletes. PM R 2023; 15:1493-1506. [PMID: 36929699 DOI: 10.1002/pmrj.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 02/06/2023] [Accepted: 02/10/2023] [Indexed: 03/18/2023]
Abstract
Platelet-rich plasma (PRP) injections represent a growing interest in the use of biologic therapies for treatment of musculoskeletal injuries. One possible application of PRP is in the management of overuse injuries commonly experienced by athletes. The aim of this review is to evaluate and summarize existing evidence regarding the efficacy of PRP in the treatment of Achilles tendinopathy and plantar fasciitis in athletes. Although many lower quality single-armed studies have demonstrated clinical improvement in athletes treated for Achilles tendinopathy with PRP, higher quality randomized controlled trials (RCTs) have shown no clear benefit in athletes. Existing data suggest PRP significantly improves clinical outcomes for plantar fasciitis in the general population, but very few studies and no RCTs are available that specifically analyze outcomes in athletic populations. More research is needed to evaluate how platelet concentration, leukocyte and erythrocyte presence, and sport type may interact to affect clinical outcomes in athletes.
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Affiliation(s)
- Dustin Sneed
- Central Virginia VA Health Care System, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
| | - Carmen Wong
- Central Virginia VA Health Care System, Virginia Commonwealth University School of Medicine, Richmond, Virginia, USA
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Tas NP, Kaya O. Treatment of Plantar Fasciitis in Patients with Calcaneal Spurs: Radiofrequency Thermal Ablation or Extracorporeal Shock Wave Therapy? J Clin Med 2023; 12:6503. [PMID: 37892641 PMCID: PMC10607467 DOI: 10.3390/jcm12206503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES We aimed to compare the effectiveness of ESWT (Extracorporeal Shock Wave Therapy) and RFA (Radiofrequency Thermal Ablation) on pain, disability, and activity limitation in the treatment of plantar fasciitis in patients with calcaneal spurs. MATERIALS AND METHODS Patients who apply to Orthopedics and Traumatology and Physical Medicine and Rehabilitation departments with a complaint of heel pain are included in this retrospective study. We included patients diagnosed with calcaneal spurs who received treatment with ESWT (n = 80) and RFA (n = 79) between 1 August 2021 and 1 September 2022. All patients were evaluated using the Visual Analog Scale (VAS), Foot Function Index (FFI), and the Roles and Maudsley score (RM) before and after treatment. An evaluation was performed on average 6 months after treatment. RESULTS This study included 79 RFA patients (34 females and 45 males) with a mean age of 55.8 ± 9.6 years and 80 ESWT patients (20 females and 60 males) with a mean age of 49.1 ± 9.5 years. There was a significant decrease in VAS scores after treatment in both the RFA and ESWT groups (z: -4.98, z: -5.18, respectively, p < 0.001). The reductions in FFI pain, FFI activity restriction, FFI disability, and RM scores were significant in both groups, although the scores after treatment were lower in the RFA group. CONCLUSIONS This study demonstrates that ESWT and RFA significantly reduced pain, disability, and activity restriction in the treatment of plantar fasciitis in patients with calcaneal spurs. ESWT proved particularly effective in alleviating pain, whereas RFA had more pronounced effects on reducing disability and activity limitations. The choice of treatment should be based on the patient's specific complaints.
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Affiliation(s)
- Nevsun Pihtili Tas
- Department of Physical Medicine and Rehabilitation, Health Sciences University Elazig Fethi Sekin City Hospital, Elazıg 23280, Turkey
| | - Oğuz Kaya
- Department of Orthopedics and Traumatology, Elazig Fethi Sekin City Hospital, Elazıg 23280, Turkey;
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Sathyendra K, Dnyandeo Solankey R, Singh M, Venkatesh kumar S, Singh G, Gupta MM. Comparative study of local injections of autologous platelet rich plasma versus corticosteroid in management of chronic plantar fasciitis. J Clin Orthop Trauma 2023; 43:102225. [PMID: 37520269 PMCID: PMC10382913 DOI: 10.1016/j.jcot.2023.102225] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/14/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023] Open
Abstract
Background Plantar fasciitis is a known degenerative pathology and is a common cause of heel pain. We intend to evaluate the efficacy between locally injected Corticosteroids and autologous PRP in the management of chronic plantar fasciitis patients. Materials and methods In this prospective randomized controlled study, 70 chronic plantar fasciitis with failed conservative management for 3 months were randomly selected into 2 groups of 35 patients each. Group A received a local autologous platelet rich plasma injection of 3 ml and group B received a local corticosteroid injection of 2 ml. The Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) scores were compared between the groups at 15 days, 1 month, 3 months and 6 months. Results No improvement in pain between autologous PRP and corticosteroids study subjects was noted in the initial period up to 15 days whereas after 1 month, 3 months and 6 months duration, it is seen that autologous PRP injected study subjects showed significant relief in pain compared to corticosteroids. Conclusion PRP was more effective in chronic plantar fasciitis patients compared to corticosteroids with pain relief coming after first 1st, 3rd and 6th month of the injection. Level of evidence Level 2.
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Affiliation(s)
- K.G. Sathyendra
- Department of Orthopaedics, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | | | - Mohit Singh
- Department of Orthopaedics, ESI-PGIMSR, Basaidarapur, New Delhi, India
| | - S. Venkatesh kumar
- Department of Orthopaedics Dhanalakshmi Srinivasan Medical College and Hospital, Siruvachur, Perambalur, 621113, Tamilnadu, India
| | - Gowtham Singh
- Department of Orthopaedics, ESI-PGIMSR, Basaidarapur, New Delhi, India
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Khammas ASA, Mahmud R, Hassan HA, Ibrahim I, Mohammed SS. An assessment of plantar fascia with ultrasound findings in patients with plantar fasciitis: a systematic review. J Ultrasound 2023; 26:13-38. [PMID: 36040577 PMCID: PMC10063743 DOI: 10.1007/s40477-022-00712-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 07/14/2022] [Indexed: 10/14/2022] Open
Abstract
INTRODUCTION Plantar fasciitis (PFS) is described by an intense pain over medial tubercle of calcaneus, increased with the first step after waking up, after rest and during weightbearing activity. It is the most common cause of plantar heel pain in adults with the prevalence estimated 10% of the general population. Ultrasound imaging is commonly being used to measure the PF thickness, evaluate the efficacy of different treatments and a guide therapeutic technique in patients with PFS. The objective of this study was to systematically review the studies that were previously published to evaluate the role of ultrasound in the assessment of PF in patients with PFS. METHODS A systematic search was carried out over the last 5 years from 2017 to 2022 on basis the following electronic databases: Science Direct, Scopus, Web of Science, Springer and PubMed. The keywords that used in the searching were: ultrasound, sonography, ultrasonography, plantar fasciitis, imaging of plantar fascia, physiotherapy of plantar fasciitis, interventional treatment of plantar fasciitis, randomized controlled trial of plantar fasciitis and interventional ultrasound. The review focused on the assessment of PF in patients with PFS underwent different interventions using B-mode, shear wave elastography (SWE) and color Doppler ultrasound. RESULTS During the search process, 1661 were recorded using the proper keywords from 2017 to 2022 in which 666 original articles were found after removing the review and duplicated articles. Of these, thirty articles met the inclusion criteria and included in this review. The articles have assessed the PF in patients with PFS under different conditions using different ultrasound modes. Twenty-six articles evaluated the effectiveness of different treatment on PF in patients with PFS using different ultrasound modes. In 8 of 26 articles, the ultrasound was used as both an assessment tool of PF and guide therapeutic technique in patients with PFS. In 18 articles, the ultrasound was used as only assessment tool to identify the PF thickness and its observation changes in patients with PFS. Four articles compared the PF thickness and its intrafascial changes between patients with PFS and healthy subjects. CONCLUSION The ultrasound can be a reliable tool in assessment the effect of different interventions on PF by evaluating its thickness, echogenicity and stiffness changes in patients with PFS. There were different methods and treatments were used among the studies.
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Affiliation(s)
- Abdul Sattar Arif Khammas
- Department of Radiological Techniques, College of Health and Medical Techniques/Baghdad, Middle Technical University, 10047, Bab Al Muadham, Baghdad, Iraq.
- Department of Radiology and Imaging, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Rozi Mahmud
- Department of Radiology and Imaging, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Hasyma Abu Hassan
- Department of Radiology and Imaging, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Idris Ibrahim
- Department of Radiology and Imaging, Faculty of Medicine and Health Sciences, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Safwan Saeed Mohammed
- Department of Radiological Techniques, College of Health and Medical Techniques/Baghdad, Middle Technical University, 10047, Bab Al Muadham, Baghdad, Iraq
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Seth I, Bulloch G, Seth N, Lower K, Rodwell A, Rastogi A, Gibson D, Bedi H. The role of corticosteroid injections in treating plantar fasciitis: A systematic review and meta-analysis. Foot (Edinb) 2023; 54:101970. [PMID: 36774828 DOI: 10.1016/j.foot.2023.101970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Plantar fasciitis is a recurrent cause of heel pain and is often treated by corticosteroid infections (CSI). The current study reviewed and analysed the role of CSI with platelet rich plasma (PRP), and CSI with extracorporeal shock wave therapy (EWST) for plantar fasciitis treatment. METHODS PubMed, Medline, Web of Science, Embase, Cochrane, and Google Scholar databases were searched for relevant studies. Preferred Reporting in Systematic Review & Meta-Analysis (PRISMA) guidelines were used to search relevant studies published from infinity to April 2021. The risk of bias was performed using Cochrane Collaboration's tool. GRADE assessment was used for quality of evidence. Data analysis was performed with the use of R software and P < 0.05 was considered statistically significant. CSI was compared with PRP and EWST. RESULTS Eighteen studies comprising 1180 patients were included in this meta-analysis. When compared to PRP, CSI with lignocaine/lidocaine had significantly higher mean difference on visual analogue scale (VAS) pain scores at 3 months (0.62 [0.13; 1.12], P = 0.01) and 6 months (MD = 1.49 [0.22; 2.76], P = 0.02). At 6 months, VAS scores were higher in the CSI group than the ESWT group (MD = 0.8 [0.38; 1.22], P = 0.1). At 6 months, a significant reduction in the American Orthopaedic Foot and Ankle Score (AOFAS) was observed in the CSI group compared to PRP (MD = - 11.53 [- 16.62; - 6.43], P < 0.0001). CONCLUSION Patients suffering from plantar fasciitis, PRP achieved better VAS scores compared to CSI at 3 and 6-month follow-up. In addition, ESWT had better VAS score outcomes at 6 months compared to CSI. Regarding AOFAS score, PRP was more efficacious than CSI at 6 months of follow-up. Only through the development of high-quality, large-scale longitudinal studies, will the findings and conclusions of this meta-analysis be strengthened and influence our clinical practice in the treatment of plantar fasciitis. LEVEL OF CLINICAL EVIDENCE II.
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Affiliation(s)
- Ishith Seth
- Department of Surgery, Peninsula Health, Victoria 3199, Australia; Faculty of Medicine and Science, Central Clinical School, Monash University, Victoria 3004, Australia.; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales 2500, Australia.
| | - Gabriella Bulloch
- Faculty of Science, Medicine and Health, University of Melbourne, Victoria 3010, Australia
| | - Nimish Seth
- Department of Surgery, Peninsula Health, Victoria 3199, Australia; Department of Orthopaedic Surgery, The Alfred Hospital, Melbourne, Victoria 3004, Australia
| | - Kirk Lower
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales 2500, Australia
| | - Aaron Rodwell
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales 2500, Australia
| | - Anish Rastogi
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales 2500, Australia
| | - Damien Gibson
- Illawarra Shoalhaven Local Health District, Wollongong Hospital, Wollongong, New South Wales 2500, Australia
| | - Harvinder Bedi
- Department of Orthopaedic Surgery, Box Hill Hospital, Melbourne, Victoria 3128, Australia
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12
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Advances in the Clinical Application of Platelet-Rich Plasma in the Foot and Ankle: A Review. J Clin Med 2023; 12:jcm12031002. [PMID: 36769649 PMCID: PMC9917505 DOI: 10.3390/jcm12031002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 01/15/2023] [Accepted: 01/18/2023] [Indexed: 01/31/2023] Open
Abstract
Autologous and recombinant biologic substances have been generated as a result of the research into the cellular features of the healing process. Orthobiologics are increasingly being used in sports medicine and musculoskeletal surgery. Nevertheless, clinical data are limited; consequently, further studies are required, particularly in foot and ankle pathologies. This review aims to provide evidence of the most recent literature results and ignite the interest of orthopedic specialists eager for an update about the most current discussion on platelet-rich plasma (PRP) clinical applications in the foot and ankle fields. Previous studies have shown that platelet-rich plasma can be beneficial in treating various conditions, such as chronic foot ulcers, osteoarthritis, Achilles tendinopathy, etc. Despite the positive effects of PRP on various musculoskeletal conditions, more prospective studies are needed to confirm its effectiveness at treating ankle and foot pathologies. In addition to clinical trials, other factors, such as the quality of the research and the procedures involved, must be considered before they can be used in patients. More long-term evaluations are needed to support or oppose its application in treating foot and ankle disorders. We present the most extensive review of PRP's clinical applications in the foot and ankle field.
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13
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Sugino Y, Yoshimura I, Hagio T, Ishimatsu T, Nagatomo M, Yamamoto T. Effect of plantar fascia-specific stretching and Achilles tendon stretching on shear wave elasticity of the plantar fascia in healthy subjects. Foot Ankle Surg 2023; 29:208-212. [PMID: 36646592 DOI: 10.1016/j.fas.2023.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/29/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
BACKGROUND The effect of stretching on the mechanical properties of the plantar fascia (PF) remain unclear. This study was performed to determine the effect of PF-specific stretching (PFSS) and Achilles tendon stretching (ATS) on the viscoelastic properties of the PF with shear wave elastography (SWE). METHODS We recruited 14 participants (8 men, 6 women) with no history of PF disorders or painful episodes. The mean age of the participants was 30.9 ± 4.8 (range, 25-41) years. All participants performed sustained PFSS (sPFSS) on one foot and intermittent PFSS (iPFSS) on the other foot. Two weeks later, all participants performed sustained ATS (sATS) on one foot and intermittent ATS (iATS) on the other foot. SWE measurements were performed immediately after each stretching. RESULTS The PF elasticity immediately before stretching ranged from 133.8 kPa to 144.7 kPa. The PF elasticity after stretching ranged from 158.9 kPa to 215.8 kPa. There was a significant increase in PF elasticity after sPFSS, iPFSS, sATS, and iATS (P < .01). The elasticity after sATS was greater than that after iATS (P = .03). In contrast, there were no differences in PF elasticity after stretching between sPFSS and iPFSS (P = .13), sPFSS and sATS (P = .17), or iPFSS and iATS (P = .50). CONCLUSIONS PF elasticity increased after stretching regardless of the frequency and type of PFSS and ATS. LEVEL OF EVIDENCE Level II, prospective cohort study.
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Affiliation(s)
- Yuki Sugino
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Ichiro Yoshimura
- Fukuoka University Faculty of Sports and Health Science, 8-19-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan.
| | - Tomonobu Hagio
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Tetsuro Ishimatsu
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
| | - Masaya Nagatomo
- Department of Orthopedic Surgery, Nagasaki Prefecture Tsushima Hospital, 1168-7 Kechiotsu, Mitsushima-machi, Tsushima-shi, Nagasaki 817-0322, Japan
| | - Takuaki Yamamoto
- Department of Orthopaedic Surgery, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka 814-0180, Japan
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14
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Gupta A, Ortiz-Babilonia C, Xu AL, Rogers D, Vulcano E, Aiyer AA. The Statistical Fragility of Platelet-Rich Plasma as Treatment for Plantar Fasciitis: A Systematic Review and Simulated Fragility Analysis. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221144049. [PMID: 36582654 PMCID: PMC9793046 DOI: 10.1177/24730114221144049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background Plantar fasciitis (PF) is the most common cause of heel pain and can be a source of extensive physical disability and financial burden. Platelet-rich plasma (PRP) offers a potentially definitive, regenerative treatment modality that, if effective, could change the current paradigm of PF care. However, randomized controlled trials (RCTs) on the clinical benefits of PRP for refractory PF offer inconsistent conclusions, potentially because of the broader limitations of using P value thresholds to declare statistical and clinical significance. In this study, we use the Continuous Fragility Index (CFI) and Quotient (CFQ) to appraise the statistical robustness of data from RCTs evaluating PRP for treatment of PF. Methods RCTs comparing outcomes after PRP injection vs alternative treatment in patients with chronic PF were evaluated. Representative simulated data sets were generated for each reported outcome event using summary statistics. The CFI was determined by manipulating each data set until reversal of significance (α=0.05) was achieved. The corresponding CFQ was calculated by dividing the CFI by the sample size. Results Of 259 studies screened, 20 studies (59 outcome events) were included in this analysis. From these simulations, the median CFI for all events was 9, suggesting that varying the treatment of 9 patients would be required to reverse trial significance. The corresponding CFQ was 0.177. Studies with reported P value <.05 were more statistically fragile (CFI=10, CFQ=0.122) than studies with reported P value >.05 (CFI=5, CFQ=0.179). Of 36 outcome events reporting lost to follow-up data, 10 events (27.8%) lost ≥9 patients. Conclusion Our findings suggest that, on average, the statistical fragility of RCTs evaluating PRP for nonoperative PF therapy is at least comparable to that of the sports medicine literature. However, several included studies had concerningly low simulated fragility scores. Orthopaedic surgeons may benefit from preferentially relying on studies with higher CFI and CFQ values when evaluating the utility of PRP for chronic PF in their own clinical practice. Given the importance of RCT data in clinical decision making, fragility indices could help give context to the stability of statistical findings. Level of Evidence Level I, systematic review.
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Affiliation(s)
- Arjun Gupta
- Department of Orthopaedic Surgery, The
Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Orthopaedic Surgery,
Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Carlos Ortiz-Babilonia
- Department of Orthopaedic Surgery, The
Johns Hopkins University School of Medicine, Baltimore, MD, USA,Department of Orthopaedic Surgery,
University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Amy L. Xu
- Department of Orthopaedic Surgery, The
Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Davis Rogers
- Department of Orthopaedic Surgery, The
Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ettore Vulcano
- Department of Orthopaedic Surgery,
Columbia University Mount Sinai Medical Center, Miami, FL, USA
| | - Amiethab A. Aiyer
- Department of Orthopaedic Surgery, The
Johns Hopkins University School of Medicine, Baltimore, MD, USA,Amiethab A. Aiyer, MD, Department of
Orthopaedic Surgery, The Johns Hopkins Hospital, 1800 Orleans St, Baltimore, MD
21287, USA.
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15
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Alessio-Mazzola M, Stambazzi C, Ursino C, Tagliafico A, Trentini R, Formica M. Ultrasound-Guided Autologous Platelet-Rich Plasma Injections Versus Focal Ultrasound-Guided Extracorporeal Shockwave Therapy for Plantar Fasciitis in Athletes and Nonathletes: A Retrospective Comparative Study With Minimum 2-Year Follow-Up. J Foot Ankle Surg 2022; 62:417-421. [PMID: 36396549 DOI: 10.1053/j.jfas.2022.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 10/08/2022] [Accepted: 10/16/2022] [Indexed: 11/05/2022]
Abstract
Plantar fasciitis is often cause of heel pain, especially in sporting-related activities. Different conservative measures for the management of plantar fasciitis were compared in several researches. The purpose of this retrospective study was to evaluate and compare clinical outcomes of chronic plantar fasciitis treated with ultrasound-guided platelet-rich plasma (PRP) and focal ultrasound-guided extracorporeal shockwave therapy (ESW). Secondarily, results on subpopulation of athletes were recorded. Fifty-five patients treated for plantar fasciitis were included, 24 among them were competitive or recreational athletes. Treatment outcomes were assessed using Visual Analog Scale and Foot Function Index before and after treatment. Time to return to sport among patients practicing sporting activities was recorded. Before treatment, no differences were observed between groups in terms of age, gender, body mass index, and months of follow up. From baseline to final follow-up assessment, significant improvement was observed in all the outcomes measures. The subgroup analysis showed no differences between patients stratified for type of treatment and sport/nonsport practitioners. The overall failure rate was higher, although not significant, in patients who underwent ESW therapy and they required a higher number of orthopedic visits. Among sports practitioners the mean time to return to sport (months) was faster in PRP group than ESW group (p = .044). PRP and ESW represent both reliable solutions for plantar fasciitis leading to good results in terms of patients' satisfaction, pain, and clinical outcomes. However, after treatment with PRP injections less recurrences in overall population and faster return to sporting activities in sports practitioners were observed.
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Affiliation(s)
| | - Chiara Stambazzi
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genova, Genova, Italy; Ospedale Policlinico San Martino, Genova, Italy
| | - Chiara Ursino
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genova, Genova, Italy; Ospedale Policlinico San Martino, Genova, Italy
| | - Alberto Tagliafico
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy; Ospedale Policlinico San Martino, Genova, Italy
| | - Roberto Trentini
- Department of Health Sciences (DISSAL), University of Genova, Genova, Italy
| | - Matteo Formica
- Department of Integrated Surgical and Diagnostic Sciences (DISC), University of Genova, Genova, Italy; Ospedale Policlinico San Martino, Genova, Italy
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16
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Johnson LG, Buck EH, Anastasio AT, Abar B, Fletcher AN, Adams SB. Efficacy of Platelet-Rich Plasma in Soft Tissue Foot and Ankle Pathology. JBJS Rev 2022; 10:01874474-202210000-00002. [PMID: 36191089 DOI: 10.2106/jbjs.rvw.22.00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
➢ The preparation methodology for platelet-rich plasma (PRP) may have important clinical implications with varying effectiveness with leukocyte, platelet, and growth factor concentrations. ➢ There is high-quality evidence to support the superiority of PRP over corticosteroids in the case of chronic plantar fasciitis. ➢ There is moderate-quality to high-quality evidence for PRP's ability to increase tendon thickness with no capacity to decrease pain, increase function, or augment percutaneous tenotomy in Achilles tendinopathy. ➢ There is insufficient evidence to support PRP injections in the definitive treatment of Achilles tendon rupture. However, PRP may contribute to postoperative recovery after tendon rupture repair, but this requires further research. ➢ The biochemical theory supporting the clinical use of PRP must be reinforced with high-level evidence research. Based on the current literature, PRP may serve as a viable treatment method in chronic plantar fasciitis. Further high-quality, comparative studies with longer clinical follow-up are required to support recommendations for use of PRP in the treatment of Achilles tendon pathology.
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Affiliation(s)
- Lindsey G Johnson
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, North Carolina
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina
| | - Erin H Buck
- Campbell University School of Osteopathic Medicine, Lillington, North Carolina
| | - Albert T Anastasio
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, North Carolina
| | - Bijan Abar
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, North Carolina
| | - Amanda N Fletcher
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, North Carolina
| | - Samuel B Adams
- Orthopaedic Surgery Department, Duke University Medical Center, Durham, North Carolina
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17
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Bildik C, Kaya O. Platelet-Rich Plasma vs Autologous Blood Injection to Treat Plantar Fasciitis: A Prospective Randomized, Double-Blinded, Controlled Trial. Foot Ankle Int 2022; 43:1211-1218. [PMID: 35975719 DOI: 10.1177/10711007221114122] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Plantar fasciitis (PF) is the most common cause of heel pain. Previous work has shown promising results regarding platelet-rich plasma (PRP) injections for the treatment of PF. The aim of this study is to prospectively compare the efficacy of PRP and autologous blood injections in a randomized anonymized patient group to treat PF. METHODS PF patients who failed at least 6 weeks of noninvasive conservative treatment aged between 40 and 65 years were recruited to be in the study. Patients were randomly assigned into group A (PRP) or group B (autologous blood). Injections were performed under ultrasonographic guidance in a double-anonymized manner. The groups were compared according to preinjection and postinjection health-related quality of life (HRQoL) scores measured with Foot and Ankle Disability Index (FADI) and visual analog scale (VAS). Intragroup comparative analysis was also performed at different time points. Independent t tests and repeated measures analyses of variance were used for statistical analysis, with P <.05 set for statistical significance. RESULTS Group A (PRP) included 30 (19 female, 11 male) patients with mean age 52.2 ±6.3; group B (ABI) included 30 (20 female, 10 male) patients with mean age 52.7 ± 6.5. Both groups had similar body mass index (P = .719). No injection-related complications were recorded. After treatment, both groups had improved FADI and VAS scores compared to the baseline. Although the mean HRQoL scores were higher in the PRP group, there was no significant difference between the 2 groups (PVAS = .589; PFADI = .742). CONCLUSION Participants with plantar fasciitis improved statistically significantly after either PRP or ABI injections compared with baseline HRQoL scores, with no significant differences seen between the groups. LEVEL OF EVIDENCE Level I, prospective randomized double-anonymized clinical comparative study.
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Affiliation(s)
- Celaleddin Bildik
- Orthopedics and Traumatology, Istanbul Atasehir Florence Nightingale, Atasehir, Istanbul, Turkey.,Faculty of Health Sciences, Istanbul Yeni Yüzyil University, Istanbul, Turkey
| | - Ozcan Kaya
- SBU Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey
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18
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Vellingiri K, S NJ, P V M, Lourdu JP, Andra Suryanarayana MS. A Prospective Study Comparing the Efficacy of Local Injection of Platelet-Rich Plasma (PRP) vs Methylprednisolone in Plantar Fasciitis. Cureus 2022; 14:e25523. [PMID: 35800843 PMCID: PMC9246436 DOI: 10.7759/cureus.25523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction Plantar fasciitis is a common musculoskeletal problem in Orthopaedic practice. Heel pain caused due to plantar fasciitis, if persistent, can cause distress to the patient, so the correct intervention at the right time is needed. Plantar fasciitis is also common in the rural population. Objectives To compare the efficacy of local injection of platelet-rich plasma (PRP) and corticosteroid (CS) (methylprednisolone) in patients with chronic plantar fasciitis, and to evaluate the safety, side effect and complications of two different modalities of treatment. Materials and methods The study period was between August 2018 and September 2020. After obtaining proper written consent, 110 patients, who were above the age of 18 years and suffering from plantar fasciitis for more than three months, were included in the study. The patient characteristics including gender, age, weight, history of heel pain, duration of symptoms and types of prior treatment were noted. All the 110 patients were subjected to four parameter assessments before administration of the PRP/CS injections. Out of the 110 patients, 55 patients received PRP injection and 55 received CS - 2 ml (40 mg) methylprednisolone with 2 ml of sterile water injections. Post administration of injections, the patients' clinical, radiological, subjective and functional outcomes were assessed at the first, third and sixth month by using the Visual Analog Scale (VAS), Foot and Ankle Outcome Instrument Core Scale (FAI), Roles and Maudsley Scores (RMS), American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale and ultrasonogram of plantar fascia thickness. Discussion In this study, 110 patients were screened and evaluated. Out of these 110 patients, five patients who received PRP and five who received CS were lost for follow-up. Out of the 110 patients, 59 were females and 41 were males. The majority of the patients were in the BMI range of 18.5 to 24.9, with a mean BMI of 23.6. Comparing the results in both the groups reflected an improvement in the group of patients who received PRP injections. Two patients had post-operative complications (superficial infection) in the PRP injection group, while 10 patients had post-procedure complications (five patients developed superficial infections, three patients developed skin depigmentation, and two patients had atrophy of fat pad) in the corticosteroid injections (CSI) group. Infections subsided in all the patients as observed during subsequent follow-up. Conclusion This study shows that PRP administration is a good method of managing patients suffering from chronic plantar fasciitis, presenting with some discomfort following activity, with more than three months of symptoms and with a VAS score of more than 6 and plantar fascia thickness of 5 mm and failed conservative management. This is evidenced by a comparison of AOFAS, FAI score and thickness of plantar fascia using an ultrasonogram before and after the procedure. This study reflects better treatment outcomes with PRP injection compared to local steroid infiltration. This is the largest series of cases studied compared to other previously available studies in the literature. PRP injections may thus be used as a superior alternative to the already available treatments for chronic heel pain.
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19
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Wheeler PC, Dudson C, Gregory KM, Singh H, Boyd KT. Autologous Blood Injection With Dry-Needling vs Dry-Needling Alone Treatment for Chronic Plantar Fasciitis: A Randomized Controlled Trial. Foot Ankle Int 2022; 43:646-657. [PMID: 35068224 DOI: 10.1177/10711007211061365] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Autologous blood injection (ABI) for patients with chronic plantar fasciitis has been promoted as an approach to improve outcomes over standard dry-needling approaches. The purpose of this trial was to investigate if there are improved outcomes following an ultrasonography-guided ABI compared to dry needling alone for patients with chronic plantar fasciitis. METHODS A double-blinded (participant-blinded and observer-blinded) RCT within a single clinic enrolled 90 patients with symptoms of plantar fasciitis that had failed to improve with a minimum of 3 months of rehabilitation. The mean age was 49.5±8.9 years, 67% were female, and the mean symptom duration was 40.0±28.2 months (range: 8 months-10 years). Participants were randomized to receive ABI or an identical dry-needle fenestration-procedure without coadministration of autologous blood. All participants received identical structured rehabilitation and were followed up at 2, 6, 12, and 26 weeks. Outcome measures included local foot pain, validated foot patient-reported outcome measures (Foot Function Index-revised, Manchester-Oxford Foot Questionnaire, Foot and Ankle Ability Measure), measures of general function and "ability" (EuroQol [EQ]-5D-5L, Oswestry Disability Index), specific measures of activity (International Physical Activity Questionnaire), sleep (Pittsburgh Sleep Quality Index), and mood (Hospital Anxiety and Depression Scale). RESULTS There were no significant between-group differences seen at any time-point studied. There were a number of statistically significant within-group improvements for local foot pain and function in both groups comparing baseline/follow-up data. Overall, levels of pain improved by 25% by 6 weeks and by 50% at 6 months. There were improvements in some generalized function markers. Activity rates did not change, demonstrating that improvements in pain did not necessarily influence physical activity. CONCLUSION Coadministration of 3 mL of autologous blood had no additional effect compared to a dry-needling procedure alone for patients with chronic plantar fasciitis. LEVEL OF EVIDENCE Level I, double-blinded randomized controlled trial.
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Affiliation(s)
- Patrick C Wheeler
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.,School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, United Kingdom.,National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom
| | - Chloe Dudson
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
| | - Kim M Gregory
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.,National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom
| | - Harjinder Singh
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom.,National Centre of Sport and Exercise Medicine, Loughborough, United Kingdom
| | - Kevin T Boyd
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester General Hospital, Leicester, United Kingdom
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20
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Kurtoglu A, Kochai A, Inanmaz ME, Sukur E, Keskin D, Türker M, Sen Z, Daldal I, Avan LY. Effectiveness of radiofrequency ablation for treatment of plantar fasciitis. Medicine (Baltimore) 2022; 101:e29142. [PMID: 35357356 DOI: 10.1097/md.0000000000029142] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/03/2022] [Indexed: 11/27/2022] Open
Abstract
Plantar fasciitis is the most common cause of heel pain. Pain can be persistent in some patients and interrupt daily activities and sportive activities. There are a lot of treatment options available for plantar fasciitis. We hypothesized that patients with chronic persistent plantar fasciitis can be successfully treated with radiofrequency nerve ablation (RFNA).Two hundred sixty-one patients with plantar fasciitis (378 feet) treated with RFNA from February 2017 to January 2019 were retrospectively assessed. All the patients had plantar heel pain for at least 6months. Based on their body mass index (BMI), the enrolled patients were divided into obese (BMI ≥ 30kg/m2) and non-obese (BMI < 30kg/m2) groups. The patients were asked to complete a questionnaire just before and after the procedure and during the final follow-up. The BNS Radiofrequency Lesion Generator was used during a single session. The patients' information, including their visual analogue scale (VAS) score and American Orthopaedic Foot and Ankle Society (AOFAS) score, was assessed. During their final follow-up, the patients were asked to rate the success of their treatment by choosing one of the following options: completely successful, very successful, moderately successful, marginally successful, or not successful.The VAS and AOFAS scores of all the patients were evaluated pre-procedure, in the first month after procedure, and during the final follow-up (8-24 months). There was a statistically significant difference between the pre-procedure and postprocedure VAS scores (P < .001), there was no statistically significant difference between the VAS scores in the first month postprocedure and during the final follow-up.There was a statistically significant difference between the pre-procedure and postprocedure AOFAS scores (P < .001), there was no statistically significant difference between the AOFAS scores in the first month postprocedure and during the final follow-up.RFNA can be used as an alternative method to surgical procedures for treating plantar fasciitis because it is safe and effective. The advantages of RFNA are that patients can quickly return to their work and resume weight-bearing activities.
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Affiliation(s)
- Alper Kurtoglu
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
| | - Alauddin Kochai
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
| | | | - Erhan Sukur
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
| | - Dogan Keskin
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
| | - Mehmet Türker
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
| | - Zafer Sen
- University of Health Sciences, Konya City Hospital Orthopedics and Traumatology, Turkey
| | - Ismail Daldal
- Lokman Hekim Akay Hospital, Department of Orthopaedic and Traumatology, Ankara, Turkey
| | - Laçin Yüksel Avan
- Sakarya University Research and Training Hospital, Adapazari, Sakarya, Turkey
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Similar Benefits Seen After Radial Extracorporeal Shockwave Therapy or Autologous Blood Injection in Patients With Chronic Plantar Fasciitis-A Retrospective Cohort Study. Clin J Sport Med 2022; 32:e107-e115. [PMID: 34267064 DOI: 10.1097/jsm.0000000000000930] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 02/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the outcomes for patients with chronic plantar fasciitis after extracorporeal shockwave therapy (ESWT) or autologous blood injection (ABI). DESIGN Cohort study-retrospective analysis of prospectively collected data. SETTING Hospital-based Sports Medicine Outpatient Clinic. PATIENTS One hundred two consecutive patients with chronic plantar fasciitis, treated with either radial-ESWT (rESWT) (n = 54) or ABI (n = 48), with minimum 3-month follow-up and 96% (98/102) having 6-month follow-up. Mean age 49.5 years and mean duration of symptoms 37.5 months before treatment. INTERVENTIONS Patients received either 3 sessions of radial ESWT (one session per week for 3 weeks), or a single ultrasound-guided dry needling and ABI (3 mL whole autologous blood). All patients received standardized after-care, including progressive structured home exercise program of flexibility, strengthening, and proprioception exercises. MAIN OUTCOME MEASURES 0 to 10 numerical rating scale (NRS) for self-reported "average pain" and "average stiffness" values. Secondary outcome measures included assessments of local foot function [including Manchester-Oxford Foot Questionnaire (MOXFQ), revised-Foot Function Index] as well as markers of mental health functioning (HAD), global health (EQ-5D-5L), and physical activity (International Physical Activity Questionnaire). RESULTS This study demonstrated statistically significant improvements in self-reported measures of pain and local foot function after either procedure at 6 weeks, 3 months, and 6 months, but no statistically significant differences were seen between groups at any time-period studied. At 6 months, the average pain using a 0 to 10 NRS was improved from 6.8 ± 1.8 to 4.0 ± 2.7 (P < 0.001) after ESWT and from 7.1 ± 1.6 to 3.8 ± 2.7 (P < 0.001) after ABI. At 6 months, significant improvements were seen following either group using a number of different validated patient-rated outcome measures assessing local foot pain and function, eg, the total score for MOXFQ improved from 56.1 ± 12.8 to 42.5 ± 16.6 (P < 0.001) after ESWT and from 58.8 ± 13.2 to 44.2 ± 19.2 (P < 0.001) after ABI. However, measures of physical activity or wider aspects of patient functioning did not consistently improve from baseline values to follow-up periods. CONCLUSIONS Patients with chronic plantar fasciitis improved to statistically significant extent after either rESWT or ABI procedures, with no significant differences seen between groups. The lack of randomization in this pragmatic study is noted, which may have influenced the outcome seen. Potentially larger and more robust studies are required to investigate this treatment comparison further.
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Prediction of clinical response to corticosteroid or platelet-rich plasma injection in plantar fasciitis with MRI: A prospective, randomized, double-blinded study. Diagn Interv Imaging 2021; 103:217-224. [PMID: 34844893 DOI: 10.1016/j.diii.2021.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 10/26/2021] [Accepted: 10/29/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study was to identify association between magnetic resonance imaging (MRI) features and clinical data at baseline and six months following platelet-rich plasma (PRP) or corticosteroid (CS; cortivazol) injection in patients with plantar fasciitis, and to identify initial MRI criteria associated with a favorable clinical response to treatment. MATERIAL AND METHODS The study was registered on ClinicalTrials.gov (NCT03857334). MRI examinations of 36 patients with plantar fasciitis lasting more than 3 months who were randomly assigned to receive ultrasound-guided PRP (PRP group, 20 patients) or CS (CS group, 18 patients) injection were quantitatively and qualitatively analyzed with respect to plantar fascia thickness, plantar fascia hyperintensity on T2-weighted STIR (HSTIR) images, calcaneal bone marrow and surrounding soft tissues. Clinical evaluation including visual analytic scale (VAS) assessment and MRI examinations were obtained before and 6 months after treatment. Good clinical response was defined as pain VAS decrease > 50% at 6 months. ROC curves with AUC measurements were used to determine cut-off points. RESULTS In the whole study population, an association was found between MRI features (deep soft tissue and calcaneal bone marrow HSTIR) and pain VAS scores for the first steps of the day (P = 0.028 and P = 0.007, respectively). No significant radioclinical associations on post-treatment MRI examinations were found in either group. Initial coronal thickness of plantar fascia was associated with a good clinical response in the CS group (P < 0.01). ROC curve analysis found that 7-mm or thicker plantar aponeurosis at initial MRI was predictive of good clinical response in patients with CS treatment (Youden index = 0.6). PRP infiltrations were effective regardless of fascia thickness (73% of patients with ≤ 7 mm aponeurosis and 67% for thicker ones). CONCLUSION Initial facia thickness (> 7 mm) is predictive of good clinical response six months after CS injection, whereas PRP injection shows effectiveness regardless of fascia thickness.
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Fei X, Lang L, Lingjiao H, Wei C, Zhou X. Platelet-rich plasma has better mid-term clinical results than traditional steroid injection for plantar fasciitis: A systematic review and meta-analysis. Orthop Traumatol Surg Res 2021; 107:103007. [PMID: 34217867 DOI: 10.1016/j.otsr.2021.103007] [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] [Received: 12/17/2019] [Revised: 08/18/2020] [Accepted: 09/14/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION Recently, local platelet-rich plasma (PRP) injection has been gradually used in the treatment of plantar fasciitis (PF). However, compared with traditional steroid injection, the clinical results of local PRP injection for PF patients remain controversial. Therefore, we performed a systematic review to focus on two questions as follows: (1) is PRP more effective than steroid to relieve pain in PF patients? (2) is PRP more effective than steroid to improve the foot and ankle function of PF patients? HYPOTHESIS The PRP could be more effective to relieve pain and improve the foot and ankle function in PF patients. MATERIAL AND METHODS We systematically searched electronic databases (Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, Web of Science, and Embase) from inception to October 20, 2019. The data of clinical results, including visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) scores, were extracted and analyzed. RESULTS Finally, twelve randomized controlled trials (RCT), involving 653 PF patients, were enrolled. All enrolled trials were considered to be of high quality. The results showed that the VAS of the PRP group was significantly lower than that of the steroid group at 6-month (p=0.02), 1-year (p=0.02), and 1.5-year (p<0.00001) follow-up. The AOFAS scores of the PRP group were significantly higher than that of the steroid group at 1-year (p=0.005) follow-up. DISCUSSION Compared to local steroid injection, local autologous PRP injection is more effective in relieving pain and improving the foot and ankle function at mid-term follow-up. LEVEL OF EVIDENCE II; Systematic review and Meta-analysis.
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Affiliation(s)
- Xing Fei
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, 610041 Chengdu, Sichuan, People's Republic of China
| | - Li Lang
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, 610041 Chengdu, Sichuan, People's Republic of China
| | - Hu Lingjiao
- Department of Gastroenterology, Nanxishan Hospital of Guangxi Zhuang Autonomous Region, No. 46 Chongxin Road, 541002 Guilin City, Guangxi Zhuang Autonomous Region, People's Republic of China
| | - Chen Wei
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, 610041 Chengdu, Sichuan, People's Republic of China
| | - Xiang Zhou
- Department of Orthopaedics, West China Hospital, Sichuan University, No. 37 Guoxue Lane, 610041 Chengdu, Sichuan, People's Republic of China.
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Plantar Fasciitis: Distal Tarsal Tunnel (Baxter's Nerve) in the Athlete. OPER TECHN SPORT MED 2021. [DOI: 10.1016/j.otsm.2021.150854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zhang C, Wu J, Li X, Wang Z, Lu WW, Wong TM. Current Biological Strategies to Enhance Surgical Treatment for Rotator Cuff Repair. Front Bioeng Biotechnol 2021; 9:657584. [PMID: 34178957 PMCID: PMC8226184 DOI: 10.3389/fbioe.2021.657584] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 04/07/2021] [Indexed: 01/08/2023] Open
Abstract
Rotator cuff tear is one of the most common shoulder problems encountered by orthopedic surgeons. Due to the slow healing process and high retear rate, rotator cuff tear has distressed millions of people all around the world every year, especially for the elderly and active athletes. This disease significantly impairs patients' motor ability and reduces their quality of life. Besides conservative treatment, open and arthroscopic surgery contributes a lot to accelerate the healing process of rotator cuff tear. Currently, there are many emerging novel treatment methods to promote rotator cuff repair. A variety of biological stimulus has been utilized in clinical practice. Among them, platelet-rich plasma, growth factors, stem cells, and exosomes are the most popular biologics in laboratory research and clinical trials. This review will focus on the biologics of bioaugmentation methods for rotator cuff repair and tendon healing, including platelet-rich plasma, growth factors, exosomes and stem cells, etc. Relevant studies are summarized in this review and future research perspectives are introduced.
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Affiliation(s)
- Cheng Zhang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Jun Wu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Xiang Li
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Zejin Wang
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Weijia William Lu
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- Center for Human Tissues and Organs Degeneration, Shenzhen Institutes of Advanced Technology (CAS), Shenzhen, China
| | - Tak-Man Wong
- Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Guangdong Engineering Technology Research Center for Orthopaedic Trauma Repair, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Alkhatib N, Salameh M, Ahmed AF, Alkaramany E, Ahmed G, Mekhaimar MM, Alsaei J. Platelet-Rich Plasma Versus Corticosteroids in the Treatment of Chronic Plantar Fasciitis: A Systematic Review and Meta-analysis of Prospective Comparative Studies. J Foot Ankle Surg 2021; 59:546-552. [PMID: 32354511 DOI: 10.1053/j.jfas.2019.10.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 10/02/2019] [Indexed: 02/03/2023]
Abstract
Plantar fasciitis is a common cause of heel pain, which often results in a significant limitation of daily activity. The objective of this review was to compare platelet-rich plasma injection (PRP) and corticosteroids injection in the treatment of chronic plantar fasciitis. MEDLINE, PubMed, Web of Science, EMBASE, and the Cochrane library of clinical trials were searched in March 2019. Inclusion criteria were prospective comparative studies reporting functional scores or pain score with a minimum follow-up of 1 month. We excluded studies with patients younger than 18 years and patients with a history of surgical intervention, infection, or rheumatological disease. First author, publication year, sample size, type of intervention, outcome measures, and follow-up period were recorded. The American Orthopaedic Foot & Ankle Society score was significantly better in the PRP group at 6 months' follow-up, with a lower visual analogue scale at 6- and 12-month intervals. The Foot and Ankle Disability Index and Roles-Maudsley score were similar in the 2 treatments at 3 and 6 months. PRP injection in the treatment of chronic plantar fasciitis is considered safe, with a favorable functional outcome and pain control at intermediate and long-term follow-up in comparison to corticosteroid injection.
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Affiliation(s)
- Nedal Alkhatib
- Resident Orthopedic Surgeon, Orthopedic Surgery Department, Hamad General Hospital, Doha, Qatar
| | - Motasem Salameh
- Resident Orthopedic Surgeon, Orthopedic Surgery Department, Hamad General Hospital, Doha, Qatar
| | - Abdulaziz F Ahmed
- Resident Orthopedic Surgeon, Orthopedic Surgery Department, Hamad General Hospital, Doha, Qatar
| | - Eslam Alkaramany
- Resident Orthopedic Surgeon, Orthopedic Surgery Department, Hamad General Hospital, Doha, Qatar
| | - Ghalib Ahmed
- Associate Professor, Orthopedic Surgery Department, Hamad General Hospital, Doha, Qatar
| | - Mohamed M Mekhaimar
- Associate Professor and Orthopedic Surgeon, Orthopedic Surgery Department, Hamad General Hospital, Doha, Qatar
| | - Jasim Alsaei
- Clinical Fellow and Foot & Ankle Surgeon, Orthopedic Surgery Department, Hamad General Hospital, Doha, Qatar.
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Hohmann E, Tetsworth K, Glatt V. Platelet-Rich Plasma Versus Corticosteroids for the Treatment of Plantar Fasciitis: A Systematic Review and Meta-analysis. Am J Sports Med 2021; 49:1381-1393. [PMID: 32822236 DOI: 10.1177/0363546520937293] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Plantar fasciitis is a common cause of heel pain. Corticosteroid injections are commonly used and proven to be effective, and lately platelet-rich plasma (PRP) has been used with mixed results. PURPOSE To perform a systematic review and meta-analysis comparing intralesional injections of PRP and steroid infiltration. STUDY DESIGN Systematic review and meta-analysis. METHODS A systematic review of Medline, Embase, Scopus, and Google Scholar including all level 1 and 2 studies from 2010 to 2019 was perfomed. American Orthopaedic Foot and Ankle Society and visual analog scale for pain scores were used as outcome variables. Publication bias and risk of bias was assessed with the Cochrane Collaboration tools. The Grading of Recommendations, Assessment, Development and Evaluations system was used to assess the quality of the body of evidence. Heterogeneity was assessed with χ2 and I2 statistics. RESULTS Fifteen studies were included in the analysis. Nine studies had a high risk of bias. There was 1 study with high quality, 9 with moderate, 2 studies with low, and 3 with very low quality. The pooled estimate for the American Orthopaedic Foot and Ankle Society score demonstrated nonsignificant differences at 1 month (P = .4) and 3 months (P = .076). At 6 months (P = .009) and 12 months (P = .009), it indicated significant differences in favor of PRP. The pooled estimate for visual analog scale demonstrated nonsignificant differences at 1 month (P = .653). At 3 months (P = .0001), 6 months (P = .002), and 12 months (P = .019), it yielded significant differences in favor of PRP. CONCLUSION The results of this systematic review and meta-analysis suggest that PRP is superior to corticosteroid injections for pain control at 3 months and lasts up to 1 year. In the short term, there is no advantage of corticosteroid infiltration. However, the low study quality, high risk of bias, and different protocols for PRP preparation reduce the internal and external validity of these findings, and these results must be viewed with caution.
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Affiliation(s)
- Erik Hohmann
- Faculty of Health Sciences, Medical School, University of Pretoria, Pretoria, South Africa.,Department of Orthopaedic Surgery and Sports Medicine, Valiant Clinic/Houston Methodist Group, Dubai, United Arab Emirates
| | - Kevin Tetsworth
- Department of Orthopaedic Surgery, Royal Brisbane Hospital, Herston, Australia.,Department of Surgery, School of Medicine, University of Queensland, Herston, Australia.,Limb Reconstruction Center, Macquarie University Hospital, Macquarie Park, Australia.,Orthopaedic Research Centre of Australia, Brisbane, Australia
| | - Vaida Glatt
- Orthopaedic Research Centre of Australia, Brisbane, Australia.,Department of Orthopaedics, University of Texas Health Science Center, San Antonio, Texas, USA
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Abstract
CONTEXT Injections are commonly used by health care practitioners to treat foot and ankle injuries in athletes despite ongoing questions regarding efficacy and safety. EVIDENCE ACQUISITION An extensive literature review was performed through MEDLINE, Google Scholar, and EBSCOhost from database inception to 2021. Keywords searched were injections, athletes, sports, foot and ankle, corticosteroids, platelet-rich plasma, and placental tissue. Search results included articles written in the English language and encompassed reviews, case series, empirical studies, and basic science articles. STUDY DESIGN Clinical review. LEVEL OF EVIDENCE Level 4. RESULTS Corticosteroids, platelet-rich plasma/autologous blood, anesthetic, and placental tissue injections are commonly used in the treatment of foot and ankle injuries. Primary indications for injections in athletes include plantar fasciitis, Achilles tendinosis, isolated syndesmotic injury, and ankle impingement with varying clinical results. CONCLUSIONS Despite promising results from limited case series and comparative studies, the data for safety and efficacy of injections for foot and ankle injuries in athletes remain inconclusive.
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Affiliation(s)
- Jonathan K Ochoa
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, California
| | - Christopher E Gross
- Department of Orthopaedics, Medical University of South Carolina, Charleston, South Carolina
| | - Robert B Anderson
- Bellin Health Titletown Sports Medicine and Orthopedics, Green Bay, Wisconsin
| | - Andrew R Hsu
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, California
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Mohammed W, Farah S, Nassiri M, McKenna J. Therapeutic efficacy of platelet-rich plasma injection compared to corticosteroid injection in plantar fasciitis: A systematic review and meta-analysis. J Orthop 2020; 22:124-134. [PMID: 32336895 PMCID: PMC7177161 DOI: 10.1016/j.jor.2020.03.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/26/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This study summarizes all literature assessing the long term effects of platelet-rich plasma (PRP) injection compared to corticosteroid injection to relieve pain and improve function in Plantar Fasciitis patients. MATERIALS AND METHODS This is a PRISMA compliant systematic review of 5 databases and include a meta-analysis of Randomized Controlled Trial data comparing the two injections. RESULTS Ten prospective trials were included with total number of 543 participants. The PRP group had significantly better pain scores at 3 months and 6 months follow-up. CONCLUSION PRP injections provide better pain relief, compared to corticosteroids, in patients with plantar fasciitis.
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Affiliation(s)
- Wafi Mohammed
- Tallaght University Hospital, Tallaght, Dublin 24, Ireland
| | - Salma Farah
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
| | | | - Johnny McKenna
- Tallaght University Hospital, Tallaght, Dublin 24, Ireland
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30
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Whittaker GA, Munteanu SE, Roddy E, Menz HB. Measures of Foot Pain, Foot Function, and General Foot Health. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:294-320. [PMID: 33091250 DOI: 10.1002/acr.24208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 04/02/2020] [Indexed: 12/26/2022]
Affiliation(s)
- Glen A Whittaker
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Shannon E Munteanu
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Edward Roddy
- Primary Care Centre Versus Arthritis, Chesterfield, UK, School of Primary, Community and Social Care, Keele University, Keele, UK, and Haywood Academic Rheumatology Centre, Midland Partnership NHS Foundation Trust, Stoke-on-Trent, UK
| | - Hylton B Menz
- School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Yu T, Xia J, Li B, Zhou H, Yang Y, Yu G. Outcomes of platelet-rich plasma for plantar fasciopathy: a best-evidence synthesis. J Orthop Surg Res 2020; 15:432. [PMID: 32958046 PMCID: PMC7504858 DOI: 10.1186/s13018-020-01783-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 07/02/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Plantar fasciopathy (PF) is a very common disease, affecting about 1/10 people in their lifetime. Platelet-rich plasma (PRP) had been demonstrated to be useful in achieving helpful effects for plantar fasciopathy. The purpose of this study was to compare the pain and functional outcomes between PRP and corticosteroid (CS) or placebo for plantar fasciopathy through meta-analysis and provide the best evidence. METHODS Literature was searched systematically to explore related studies that were published in Cochrane Library, PubMed, Embase, Medline, SpringerLink, OVID, and ClinicalTrials.gov . Articles regarding comparative research about the outcomes of PRP therapy and CS or placebo injection were selected. Data of pain and functional outcomes was extracted and imported into Reviewer Manager 5.3 to analyze. RESULTS Thirteen RCTs were included and analyzed. Analysis results showed significant superiority of PRP in outcome scores when compared with CS (VAS: MD = - 0.85, P < 0.0001, I2 = 85%; AOFAS: MD = 10.05, P < 0.0001, I2 = 85%), whereas there is no statistical difference in well-designed double-blind trials (VAS: MD = 0.15, P = 0.72, I2 = 1%; AOFAS: MD = 2.71, P = 0.17, I2 = 0%). In the comparison of the PRP and the placebo, the pooled mean difference was - 3.76 (P < 0.0001, 95% CI = - 4.34 to - 3.18). CONCLUSIONS No superiority of PRP had been found in well-designed double-blind studies, whereas it is implied that the outcomes of PRP are better than placebo based on available evidence.
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Affiliation(s)
- Tao Yu
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Jiang Xia
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Bing Li
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
| | - Haichao Zhou
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Yunfeng Yang
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China.
| | - Guangrong Yu
- Department of Orthopedic Surgery, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
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Huang K, Giddins G, Wu LD. Platelet-Rich Plasma Versus Corticosteroid Injections in the Management of Elbow Epicondylitis and Plantar Fasciitis: An Updated Systematic Review and Meta-analysis. Am J Sports Med 2020; 48:2572-2585. [PMID: 31821010 DOI: 10.1177/0363546519888450] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Platelet-rich plasma (PRP), as a promising alternative to traditional corticosteroid (CS), is now increasingly used in the treatment of elbow epicondylitis (EE) and plantar fasciitis (PF). To date, however, the synthesis of information on the clinical efficacy of PRP versus CS is limited with divergent conclusions. PURPOSE To compare the clinical efficacy of PRP and CS injections in reducing pain and improving function in EE and PF. STUDY DESIGN Systematic review and meta-analysis. METHODS Online databases were searched from inception to October 2018 for prospective studies evaluating PRP versus CS injections for EE or PF. Independent reviewers undertook searches, screening, and risk-of-bias appraisals. The primary outcomes of interest were pain and function in both the short term (1-3 months) and the long term (≥6 months). RESULTS Twenty trials with 1268 participants were included. For EE, PRP provides a statistically and clinically meaningful long-term improvement in pain, with a very large effect size of -1.3 (95% CI, -1.9 to -0.7) when compared with CS, but the evidence level was low. For EE, there was moderate evidence that CS provides a statistically meaningful improvement in pain in the short term, with a medium effect size of 0.56 (95% CI, 0.08-1.03) as compared with PRP; this improvement might not be clinically significant. For PF, there was low evidence that PRP provides a statistically and clinically meaningful long-term improvement in function (American Orthopedic Foot & Ankle Society score), with a very large effect size of 1.94 (95% CI, 0.61-3.28). There were no significant differences between the groups in improvement in function in EE and pain and short-term function in PF, but the quality of the evidence was low. CONCLUSION The use of PRP yields statistically and clinically better improvement in long-term pain than does CS in the treatment of EE. The use of PRP yields statistically and clinically better long-term functional improvement than that of CS in the treatment of PF.
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Affiliation(s)
- Kai Huang
- Department of Orthopaedic Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Grey Giddins
- Department of Orthopaedic Surgery, Royal United Hospital Bath, Bath, UK
| | - Li-Dong Wu
- Department of Orthopaedic Surgery, The Second Hospital of Medical College, Zhejiang University, Hangzhou, China
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Tseng W, Uy J, Chiu Y, Chen W, Vora A. The Comparative Effectiveness of Autologous Blood‐derived Products Versus Steroid Injections in Plantar Fasciitis: A Systematic Review and Meta‐analysis of Randomized Controlled Trials. PM R 2020; 13:87-96. [DOI: 10.1002/pmrj.12373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 02/25/2020] [Accepted: 03/20/2020] [Indexed: 12/21/2022]
Affiliation(s)
- Wen‐Che Tseng
- Department of Epidemiology, Harvard T.H. Chan School of Public Health Harvard University Boston MA USA
- Department of Physical Medicine and Rehabilitation National Taiwan University Hospital Taipei Taiwan
| | - Jhanna Uy
- Department of Epidemiology, Harvard T.H. Chan School of Public Health Harvard University Boston MA USA
| | - Yi‐Hsiang Chiu
- Department of Physical Medicine and Rehabilitation National Taiwan University Hospital Taipei Taiwan
| | - Wen‐Shiang Chen
- Department of Physical Medicine and Rehabilitation National Taiwan University Hospital Taipei Taiwan
| | - Ariana Vora
- Department of Physical Medicine Harvard Medical School, Harvard University Boston MA USA
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Hurley ET, Shimozono Y, Hannon CP, Smyth NA, Murawski CD, Kennedy JG. Platelet-Rich Plasma Versus Corticosteroids for Plantar Fasciitis: A Systematic Review of Randomized Controlled Trials. Orthop J Sports Med 2020; 8:2325967120915704. [PMID: 32426407 PMCID: PMC7222276 DOI: 10.1177/2325967120915704] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 10/17/2019] [Indexed: 01/08/2023] Open
Abstract
Background: Plantar fasciitis is the most common cause of plantar heel pain. Several
recent randomized control trials (RCTs) have been published comparing the
use of platelet-rich plasma (PRP) and corticosteroids (CSs) for the
treatment of plantar fasciitis. Purpose: To perform a systematic review of RCTs to compare whether PRP or CS
injections result in decreased pain levels and improved patient outcomes in
the treatment of plantar fasciitis. Study Design: Systematic review; Level of evidence, 1. Methods: Medline, EMBASE, and the Cochrane Library were screened according to the
PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)
guidelines to identify RCTs comparing PRP and CS injections for plantar
fasciitis. The visual analog scale (VAS) pain scores and the American
Orthopaedic Foot and Ankle Society (AOFAS) scores were compared between
groups at 1, 1.5, 3, 6, and 12 months, where possible. Statistical analysis
was performed using RevMan, and P < .05 was considered
to be statistically significant. Results: A total of 9 RCTs were identified comparing 239 patients with PRP with 240
patients with CS injections. At the follow-up time points, including 1-1.5,
3, 6, and 12 months, there were statistically significant differences in VAS
scores in favor of PRP (P = .004, P <
.00001, P < .00001, and P < .00001,
respectively). At 1 and 3 months, there was no difference in AOFAS scores
(P = .76 and P = .35, respectively).
However, at 6 and 12 months, there was a difference in AOFAS scores in favor
of PRP (P < .00001 and P < .00001,
respectively). Conclusion: In patients with chronic plantar fasciitis, the current clinical evidence
suggests that PRP may lead to a greater improvement in pain and functional
outcome over CS injections.
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Affiliation(s)
- Eoghan T Hurley
- NYU Langone Health, New York, New York, USA.,Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Yoshiharu Shimozono
- NYU Langone Health, New York, New York, USA.,Kyoto University Graduate School of Medicine, Department of Orthopaedic Surgery, Kyoto, Japan
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Townsend C, Von Rickenbach KJ, Bailowitz Z, Gellhorn AC. Post-Procedure Protocols Following Platelet-Rich Plasma Injections for Tendinopathy: A Systematic Review. PM R 2020; 12:904-915. [PMID: 32103599 DOI: 10.1002/pmrj.12347] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/13/2020] [Accepted: 01/15/2020] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Platelet-rich plasma (PRP) has been increasingly studied as a treatment for tendinopathy. Many factors may influence outcomes after PRP, including different protocols following administration. It was hypothesized that there would be heterogeneity in post-PRP protocols. LITERATURE SURVEY A systematized review of the literature on post-PRP protocols for tendinopathy was conducted using an electronic search of MEDLINE and Embase databases through September 2018. METHODOLOGY After duplicates were removed, English language articles involving adult patients who received PRP for tendinopathy were reviewed. Exclusion criteria included studies with fewer than 10 patients, PRP used to treat pathology other than tendinopathy, multiple protocols in one study, and surgical settings. Protocol specifics were extracted including nonsteroidal anti-inflammatory drugs (NSAID) restrictions before and after injection, postinjection restrictions on movement and weight bearing, use of orthoses, activity modifications, and postinjection rehabilitation protocols. Given limitations in the data, a meta-analysis was not performed. SYNTHESIS Eighty-four studies met inclusion criteria. Following PRP injection, weight-bearing restrictions were mentioned rarely (12% of protocols). Orthosis use was uncommon overall (18%) but more common in Achilles tendinopathy protocols (53%). The majority of protocols instituted a period of stretching (51%) and strengthening (54%). Stretching programs generally began 2-7 days following injection, and strengthening programs began within 2-3 weeks. Preinjection NSAID restriction was reported rarely (20%), whereas postinjection NSAID restriction was more common (56%), with a typical restriction of greater than 2 weeks (38%). Return to play or full activity was reported in 42% of protocols, most commonly at 4-6 weeks following injection. CONCLUSION Although the clinical effectiveness of PRP remains controversial, even less is known about the effect of post-PRP protocols, which may affect the outcomes attributed to PRP itself. No studies directly compare post-PRP protocols, and the protocols studied demonstrate substantial heterogeneity. Some consensus regarding post-PRP protocols exists, although the rationale for these recommendations is limited.
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Affiliation(s)
- Christine Townsend
- Department of Rehabilitation Medicine, New York-Presbyterian Rehabilitation Medicine, Weill Cornell Medical College & Columbia University Irving Medical Center, New York, NY, USA
| | - Kristian J Von Rickenbach
- Department of Rehabilitation Medicine, New York-Presbyterian Rehabilitation Medicine, Weill Cornell Medical College & Columbia University Irving Medical Center, New York, NY, USA
| | - Zachary Bailowitz
- Department of Rehabilitation Medicine, New York-Presbyterian Rehabilitation Medicine, Weill Cornell Medical College & Columbia University Irving Medical Center, New York, NY, USA
| | - Alfred C Gellhorn
- Department of Rehabilitation, Weill Cornell Medicine, New York, NY, USA
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Urits I, Smoots D, Franscioni H, Patel A, Fackler N, Wiley S, Berger AA, Kassem H, Urman RD, Manchikanti L, Abd-Elsayed A, Kaye AD, Viswanath O. Injection Techniques for Common Chronic Pain Conditions of the Foot: A Comprehensive Review. Pain Ther 2020; 9:145-160. [PMID: 32107725 PMCID: PMC7203280 DOI: 10.1007/s40122-020-00157-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Indexed: 11/05/2022] Open
Abstract
Purpose of Review This is a comprehensive literature review of the available evidence and techniques of foot injections for chronic pain conditions. It briefly describes common foot chronic pain syndromes and then reviews available injection techniques for each of these syndromes, weighing the available evidence and comparing the available approaches. Recent Findings Foot and ankle pain affects 20% of the population over 50 and significantly impairs mobility and ability to participate in activities of daily living (ADLs), as well as increases fall risk. It is commonly treated with costly surgery, at times with questionable efficacy. Injection therapy is challenging when the etiology is anatomical or compressive. Morton’s neuroma is a budging of the interdigital nerve. Steroid, alcohol, and capsaicin injections provide some benefit, but it is short lived. Hyaluronic acid (HA) injection provided long-term relief and could prove to be a viable treatment option. Achilles tendinopathy (AT) is most likely secondary to repeat tendon stress—platelet-rich-plasma (PRP) and prolotherapy have been trialed for this condition, but more evidence is required to show efficacy. Similar injections were trials for plantar fasciitis and achieved only short-term relief; however, some evidence suggests that PRP injections reduce the frequency of required therapy. Tarsal tunnel syndrome, a compressive neuropathy carries a risk of permanent neural injury if left untreated. Injection therapy can provide a bridge to surgery; however, surgical decompression remains the definitive therapy. When the etiology is inflammatory, steroid injection is more likely to provide benefit. This has been shown in several studies for gout, as well as osteoarthritis of the foot and ankle and treatment-refractory rheumatoid arthritis. HA showed similar benefit, possibly due to anti-inflammatory effects. Stem cell injections may provide the additional benefit of structure restoration. Summary Chronic foot pain is common in the general population and has significant associated morbidity and disability. Traditionally treated with surgery, these are costly and only somewhat effective. Injections provide an effective alternative financially and some evidence exists that they are effective in pain alleviation. However, current evidence is limited and the benefit described from injection therapy has been short-lived in most cases. Further studies in larger populations are required to evaluate the long-term effects of these treatments.
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Affiliation(s)
- Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Daniel Smoots
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA
| | | | - Anjana Patel
- Georgetown University School of Medicine, Washington, DC, USA
| | - Nathan Fackler
- Georgetown University School of Medicine, Washington, DC, USA
| | - Seth Wiley
- Arizona State University, Tempe, AZ, USA
| | - Amnon A Berger
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Hisham Kassem
- Department of Anesthesiology, Mount Sinai Medical Center, Miami Beach, FL, USA
| | - Richard D Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Omar Viswanath
- Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, AZ, USA.,Valley Anesthesiology and Pain Consultants - Envision Physician Services, Phoenix, AZ, USA.,Department of Anesthesiology, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
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37
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Yuan Y, Qian Y, Lu H, Kou Y, Xu Y, Xu H. Comparison of the therapeutic outcomes between open plantar fascia release and percutaneous radiofrequency ablation in the treatment of intractable plantar fasciitis. J Orthop Surg Res 2020; 15:55. [PMID: 32070392 PMCID: PMC7029454 DOI: 10.1186/s13018-020-1582-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/05/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Heel pain is one of the most common complaints in foot and ankle clinic, and one of the leading causes of heel pain is plantar fasciitis. METHODS A retrospective analysis was carried out in 31 cases (39 feet) of patients with intractable plantar fasciitis. In the enrolled 26 cases, 16 patients (19 feet) received open plantar fascia release, and the other 15 patients (20 feet) received percutaneous radiofrequency ablation. The surgical results were assessed by visual analog scale (VAS) and American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale (AOFAS-AH) before and after surgery in all patients. RESULTS All 31 patients were followed up successfully, with a mean follow-up time of 58.77 months. There were no differences of patient's demographics and characteristics information between the two groups. The average operative time of the feet in the open plantar fascia release is longer than that in the percutaneous radiofrequency ablation. Furthermore, the percutaneous radiofrequency ablation group had a shorter recovery time to normal activity than the open plantar fascia release group. There were no differences of postoperative VAS scores and the AOFAS-AH scores between the two groups. All patients reported satisfaction after either operation. CONCLUSION The symptoms of pain and limb function were significantly improved in patients both of the partial plantar fascia release treated group and the percutaneous radiofrequency ablation treated group. The two types of surgical procedures shared the same long-term curative effects. However, percutaneous radiofrequency ablation was a better technique from the point of shorter operative time and postoperative recovery time. TRIAL REGISTRATION Retrospectively registered.
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Affiliation(s)
- Yusong Yuan
- Department of Trauma and Orthopedics, Peking University People's Hospital, Peking University, 11th Xizhimen South Street, Beijing, China
| | - Yuan Qian
- Department of Trauma Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Hao Lu
- Department of Trauma and Orthopedics, Peking University People's Hospital, Peking University, 11th Xizhimen South Street, Beijing, China.,Diabetic Foot Treatment Center, Peking University People's Hospital, Peking University, Beijing, China
| | - Yuhui Kou
- Department of Trauma and Orthopedics, Peking University People's Hospital, Peking University, 11th Xizhimen South Street, Beijing, China
| | - Yangbo Xu
- Department of Bone and Joint Surgery, Affiliated Hospital of Southwest Medical University, Chongqing, China
| | - Hailin Xu
- Department of Trauma and Orthopedics, Peking University People's Hospital, Peking University, 11th Xizhimen South Street, Beijing, China. .,Diabetic Foot Treatment Center, Peking University People's Hospital, Peking University, Beijing, China.
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38
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Mariani E, Pulsatelli L. Platelet Concentrates in Musculoskeletal Medicine. Int J Mol Sci 2020; 21:ijms21041328. [PMID: 32079117 PMCID: PMC7072911 DOI: 10.3390/ijms21041328] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/29/2020] [Accepted: 02/06/2020] [Indexed: 12/02/2022] Open
Abstract
Platelet concentrates (PCs), mostly represented by platelet-rich plasma (PRP) and platelet-rich fibrin (PRF) are autologous biological blood-derived products that may combine plasma/platelet-derived bioactive components, together with fibrin-forming protein able to create a natural three-dimensional scaffold. These types of products are safely used in clinical applications due to the autologous-derived source and the minimally invasive application procedure. In this narrative review, we focus on three main topics concerning the use of platelet concentrate for treating musculoskeletal conditions: (a) the different procedures to prepare PCs, (b) the composition of PCs that is related to the type of methodological procedure adopted and (c) the clinical application in musculoskeletal medicine, efficacy and main limits of the different studies.
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Affiliation(s)
- Erminia Mariani
- Laboratorio di Immunoreumatologia e rigenerazione tissutale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
- Dipartimento di Scienze Mediche e Chirurgiche, Alma Mater Studiorum-University of Bologna, Via Massarenti 9, 40138 Bologna, Italy
- Correspondence: ; Tel.: +39-051-6366803
| | - Lia Pulsatelli
- Laboratorio di Immunoreumatologia e rigenerazione tissutale, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136 Bologna, Italy;
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39
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Latt LD, Jaffe DE, Tang Y, Taljanovic MS. Evaluation and Treatment of Chronic Plantar Fasciitis. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011419896763. [PMID: 35097359 PMCID: PMC8564931 DOI: 10.1177/2473011419896763] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Plantar fasciitis is the most common cause of chronic heel pain in adults, affecting both young active patients and older sedentary individuals. It results from repetitive stress to the plantar fascia at its origin on the medial tubercle of the calcaneus and is often associated with gastrocnemius tightness. The diagnosis can be made clinically with a focused history and physical examination; imaging is reserved for atypical presentations and those that do not respond to initial treatment. The most common presenting symptom is aching plantar heel pain, which is worst with first step in the morning or after periods of rest. Diagnosis is confirmed with point tenderness at the origin of the plantar fascia on the medial tubercle of the calcaneus. Initial treatment consists of activity modification, anti-inflammatory medication, gastrocnemius and plantar fascia stretching, and an in-shoe orthosis that lifts and cushions the heel. These nonoperative treatments lead to complete resolution of pain in 90% of patients but can take 3-6 months. Patients who remain symptomatic despite a 6-month trial of nonoperative therapy may be considered for minimally invasive treatment or surgery. Platelet-rich plasma injections and therapeutic ultrasound are among a number of minimally invasive treatments that stimulate the body's healing response. Corticosteroid injections temporarily relieve pain, but may increase the risk of plantar fascia rupture and fat pad atrophy. Botulinum toxin injections relax the calf muscles, which decreases the stress in the plantar fascia. Operative treatments include gastrocnemius recession and medial head of gastrocnemius release, which decrease the stress on the plantar fascia and partial planter fasciotomy, which stimulates a healing response. LEVEL OF EVIDENCE Level V, expert opinion.
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Affiliation(s)
| | - David Eric Jaffe
- OrthoArizona–Arizona Bone and Joint Specialists, Scottsdale, AZ, USA
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40
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Soraganvi P, Nagakiran KV, Raghavendra-Raju RP, Anilkumar D, Wooly S, Basti BD, Janakiraman P. Is Platelet-rich Plasma Injection more Effective than Steroid Injection in the Treatment of Chronic Plantar Fasciitis in Achieving Long-term Relief? Malays Orthop J 2020; 13:8-14. [PMID: 31890104 PMCID: PMC6915312 DOI: 10.5704/moj.1911.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction: Plantar fasciitis is characterised by pain in the heel, which is aggravated on weight bearing after prolonged rest. Many modalities of treatment are commonly used in the management of plantar fasciitis including steroid injection. Many studies show that steroid injection provides pain relief in the short term but not long lasting. Recent reports show autologous platelet-rich plasma (PRP) injection promotes healing, resulting in better pain relief in the short as well as long term. The present study was undertaken to compare the effects of local injection of platelet-rich plasma and Corticosteroid in the treatment of chronic plantar fasciitis. Materials and methods: Patients with the clinical diagnosis of chronic plantar fasciitis (heel pain of more than six weeks) after failed conservative treatment and plantar fascia thickness more than 4mm were included in the study. Patients with previous surgery for plantar fasciitis, active bilateral plantar fasciitis, vascular insufficiency or neuropathy related to heel pain, hypothyroidism and diabetes mellitus were excluded from the study. In this prospective double-blind study, 60 patients who fulfilled the criteria were divided randomly into two groups. Patients in Group A received PRP injection and those in Group B received steroid injection. Patients were assessed with visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score. Assessment was done before injection, at six weeks, three months and six months follow-up after injection. Plantar fascia thickness was assessed before the intervention and six months after treatment using sonography. Results: Mean VAS in Group A decreased from 7.14 before injection to 1.41 after injection and in Group B decreased from 7.21 before injection to 1.93 after injection, at final follow-up. Mean AOFAS score in Group A improved from 54 to 90.03 and in Group B from 55.63 to 74.67 at six months' follow-up. The improvements observed in VAS and AOFAS were statistically significant. At the end of six months' follow-up, plantar fascia thickness had reduced in both groups (5.78mm to 3.35mm in Group A and 5.6 to 3.75 in Group B) and the difference was statistically significant. Conclusion: Local injection of platelet-rich plasma is an effective treatment option for chronic plantar fasciitis when compared with steroid injection with long lasting beneficial effect.
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Affiliation(s)
- P Soraganvi
- Department of Orthopaedics, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India.,Department of Community Medicine, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India
| | - K V Nagakiran
- Department of Orthopaedics, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India.,Department of Community Medicine, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India
| | - R P Raghavendra-Raju
- Department of Orthopaedics, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India.,Department of Community Medicine, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India
| | - D Anilkumar
- Department of Orthopaedics, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India.,Department of Community Medicine, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India
| | - S Wooly
- Department of Orthopaedics, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India.,Department of Community Medicine, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India
| | - B D Basti
- Department of Community Medicine, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India
| | - P Janakiraman
- Department of Community Medicine, PES Institute of Medical Sciences and Research Kuppam Campus, Kuppam, India
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41
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Whittaker GA, Munteanu SE, Menz HB, Bonanno DR, Gerrard JM, Landorf KB. Corticosteroid injection for plantar heel pain: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:378. [PMID: 31421688 PMCID: PMC6698340 DOI: 10.1186/s12891-019-2749-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 07/31/2019] [Indexed: 12/11/2022] Open
Abstract
Background Corticosteroid injection is frequently used for plantar heel pain (plantar fasciitis), although there is limited high-quality evidence to support this treatment. Therefore, this study reviewed randomised trials to estimate the effectiveness of corticosteroid injection for plantar heel pain. Methods A systematic review and meta-analysis of randomised trials that compared corticosteroid injection to any comparator. Primary outcomes were pain and function, categorised as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks). Results A total of 47 trials (2989 participants) were included. For reducing pain in the short term, corticosteroid injection was more effective than autologous blood injection (SMD -0.56; 95% CI, − 0.86 to − 0.26) and foot orthoses (SMD -0.91; 95% CI, − 1.69 to − 0.13). There were no significant findings in the medium term. In the longer term, corticosteroid injection was less effective than dry needling (SMD 1.45; 95% CI, 0.70 to 2.19) and platelet-rich plasma injection (SMD 0.61; 95% CI, 0.16 to 1.06). Notably, corticosteroid injection was found to have similar effectiveness to placebo injection for reducing pain in the short (SMD -0.98; 95% CI, − 2.06, 0.11) and medium terms (SMD -0.86; 95% CI, − 1.90 to 0.19). For improving function, corticosteroid injection was more effective than physical therapy in the short term (SMD -0.69; 95% CI, − 1.31 to − 0.07). When trials considered to have high risk of bias were excluded, there were no significant findings. Conclusions Based on the findings of this review, corticosteroid injection is more effective than some comparators for the reduction of pain and the improvement of function in people with plantar heel pain. However, corticosteroid injection is not more effective than placebo injection for reducing pain or improving function. Further trials that are of low risk of bias will strengthen this evidence. Registration PROSPERO registration number CRD42016053216. Electronic supplementary material The online version of this article (10.1186/s12891-019-2749-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Glen A Whittaker
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia. .,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia.
| | - Shannon E Munteanu
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Hylton B Menz
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Daniel R Bonanno
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - James M Gerrard
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - Karl B Landorf
- Discipline of Podiatry, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia.,La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
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42
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Autologous Blood-Derived Products Compared With Corticosteroids for Treatment of Plantar Fasciopathy. Am J Phys Med Rehabil 2019; 98:343-352. [DOI: 10.1097/phm.0000000000001070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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43
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Abstract
Platelet-rich plasma (PRP) is a promising treatment for musculoskeletal maladies and clinical data to date have shown that PRP is safe. However, evidence of its efficacy has been mixed and highly variable depending on the specific indication. Additional future high-quality large clinical trials will be critical in shaping our perspective of this treatment option. The heterogeneity of PRP preparations, both presently and historically, leads sweeping recommendations about its utility impossible to make. This heterogeneity has also made interpreting existing literature more complicated.
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Affiliation(s)
- Adrian D K Le
- Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA
| | - Lawrence Enweze
- Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA
| | - Malcolm R DeBaun
- Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA
| | - Jason L Dragoo
- Department of Orthopedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94063, USA.
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44
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Le ADK, Enweze L, DeBaun MR, Dragoo JL. Current Clinical Recommendations for Use of Platelet-Rich Plasma. Curr Rev Musculoskelet Med 2018; 11:624-634. [PMID: 30353479 PMCID: PMC6220007 DOI: 10.1007/s12178-018-9527-7] [Citation(s) in RCA: 180] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW This review evaluates current clinical literature on the use of platelet-rich plasma (PRP), including leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP), in order to develop evidence-based recommendations for various musculoskeletal indications. RECENT FINDINGS Abundant high-quality evidence supports the use of LR-PRP injection for lateral epicondylitis and LP-PRP for osteoarthritis of the knee. Moderate high-quality evidence supports the use of LR-PRP injection for patellar tendinopathy and of PRP injection for plantar fasciitis and donor site pain in patellar tendon graft BTB ACL reconstruction. There is insufficient evidence to routinely recommend PRP for rotator cuff tendinopathy, osteoarthritis of the hip, or high ankle sprains. Current evidence demonstrates a lack of efficacy of PRP for Achilles tendinopathy, muscle injuries, acute fracture or nonunion, surgical augmentation in rotator cuff repair, Achilles tendon repair, and ACL reconstruction. PRP is a promising treatment for some musculoskeletal diseases; however, evidence of its efficacy has been highly variable depending on the specific indication. Additional high-quality clinical trials with longer follow-up will be critical in shaping our perspective of this treatment option.
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Affiliation(s)
- Adrian D. K. Le
- Department of Orthopedic Surgery, Stanford University, 450 Broadway St, Redwood City, CA USA
- Lifemark Health Group, Toronto, ON Canada
| | - Lawrence Enweze
- Department of Orthopedic Surgery, Stanford University, 450 Broadway St, Redwood City, CA USA
| | - Malcolm R. DeBaun
- Department of Orthopedic Surgery, Stanford University, 450 Broadway St, Redwood City, CA USA
| | - Jason L. Dragoo
- Department of Orthopedic Surgery, Stanford University, 450 Broadway St, Redwood City, CA USA
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45
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Abstract
PURPOSE OF REVIEW Platelet-rich plasma has become an increasingly popular treatment option within the orthopedic community to biologically enhance and stimulate difficult-to-heal musculoskeletal tissues. This review evaluates the recent literature on platelet-rich plasma use in the treatment of foot and ankle pathologies. RECENT FINDINGS Recent literature has demonstrated platelet-rich plasma to have a possible benefit in the treatment of Achilles pathology, chronic plantar fasciitis, osteochondral lesions of the talus, ankle osteoarthritis, and diabetic foot ulcers. However, given the lack of standardization of platelet-rich plasma preparations and protocols and the predominance of low-quality studies, no definitive treatment indications exist. Platelet-rich plasma is a promising treatment option, but at present, there is only limited clinical evidence supporting its use in foot and ankle applications.
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Affiliation(s)
- Peter R Henning
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, 1400 S. Germantown Rd, Germantown, 38138, TN, USA
| | - Benjamin J Grear
- Campbell Clinic Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, 1400 S. Germantown Rd, Germantown, 38138, TN, USA.
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