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Gruber R. How to explain the beneficial effects of platelet-rich plasma. Periodontol 2000 2024. [PMID: 38600634 DOI: 10.1111/prd.12565] [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: 01/08/2024] [Revised: 02/19/2024] [Accepted: 03/02/2024] [Indexed: 04/12/2024]
Abstract
Platelet-rich plasma (PRP) is the platelet and leukocyte-containing plasmatic fraction of anticoagulated autologous blood. While evidence supporting the clinical use of PRP in dentistry is low, PRP is widely used in sports medicine, orthopedics, and dermatology. Its beneficial activity is commonly attributed to the growth factors released from platelets accumulating in PRP; however, evidence is indirect and not comprehensive. There is thus a demand to revisit PRP with respect to basic and translational science. This review is to (i) recapitulate protocols and tools to prepare PRP; (ii) to discuss the cellular and molecular composition of PRP with a focus on platelets, leukocytes, and the fibrin-rich extracellular matrix of coagulated plasma; and finally (iii) to discuss potential beneficial effects of PRP on a cellular and molecular level with an outlook on its current use in dentistry and other medical fields.
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Affiliation(s)
- Reinhard Gruber
- Department of Oral Biology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
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2
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Gopinatth V, Batra AK, Chahla J, Smith MV, Matava MJ, Brophy RH, Knapik DM. Degenerative Meniscus Tears Treated Nonoperatively With Platelet-Rich Plasma Yield Variable Clinical and Imaging Outcomes: A Systematic Review. Arthrosc Sports Med Rehabil 2024; 6:100916. [PMID: 38525288 PMCID: PMC10960087 DOI: 10.1016/j.asmr.2024.100916] [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] [Received: 10/30/2023] [Accepted: 02/14/2024] [Indexed: 03/26/2024] Open
Abstract
Purpose To perform a systematic review on clinical and radiologic outcomes for meniscus tears treated nonoperatively with platelet-rich plasma (PRP). Methods A literature search was performed according to the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using keywords and Boolean operators in SCOPUS, PubMed, Medline, and the Cochrane Central Register for Controlled Trials in April 2023. Inclusion criteria were limited to Level I to IV human studies reporting on outcomes of meniscus tears treated nonoperatively with PRP. Results A total of 6 studies, consisting of 184 patients, were identified. There was 1 Level I study and 5 Level IV studies. Mean patient age was 47.8 ± 7.9 years, with 62% (n = 114/184) being female. The medial meniscus was treated in 95.7% (n = 157/164) of patients. Mean follow-up ranged from 75.9 days to 31.9 months. Meniscus tears were generally described as chronic, degenerative, or intrasubstance. In 4 studies, magnetic resonance imaging revealed variable improvement in meniscus grade with complete healing in 0% to 44% of patients and partial healing in 0% to 40% of patients. Four of 5 studies reported significant statistical improvement in pain from baseline to final follow-up. Studies reporting on clinical outcomes showed significant improvements Lysholm score (2 studies), Knee injury and Osteoarthritis Outcome Score total score (2 studies), and Tegner score (1 study). Successful return to sport occurred in 60% to 100% of patients. Two studies reported that most patients were either very satisfied or satisfied following treatment. Conclusions The use of PRP injections for the treatment of meniscus tears led to variable results based on postoperative magnetic resonance evaluation and improvements in clinical outcomes, although the clinical significance remains unclear. The heterogeneity of PRP protocols, short-term follow-up, and lack of comparative studies limit findings. Level of Evidence Level IV, systematic review of Level I to IV studies.
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Affiliation(s)
- Varun Gopinatth
- Saint Louis University School of Medicine, St. Louis, Missouri, U.S.A
| | - Anjay K. Batra
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Jorge Chahla
- Midwest Orthopaedics at Rush University Medical Center, Chicago, Illinois, U.S.A
| | - Matthew V. Smith
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Matthew J. Matava
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Robert H. Brophy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
| | - Derrick M. Knapik
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri, U.S.A
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3
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Brinkman JC, Reeson E, Chhabra A. Acute Patellar Tendon Ruptures: An Update on Management. J Am Acad Orthop Surg Glob Res Rev 2024; 8:01979360-202404000-00011. [PMID: 38569093 PMCID: PMC10994452 DOI: 10.5435/jaaosglobal-d-24-00060] [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: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 04/05/2024]
Abstract
Patellar tendon ruptures can be debilitating injuries. When incomplete, partial tears can be managed nonsurgically with immobilization and progressive rehabilitation. Although complete ruptures remain a relatively uncommon injury, they portend a high level of morbidity. Ruptures typically result from an acute mechanical overload to the extensor mechanism, such as with forced quadriceps contraction and knee flexion. However, chronically degenerated tendons are also predisposed to failure from low-energy injuries. Diagnosis can often be made clinically with recognition of a palpable defect to the tendon, localized patellar tendon tenderness, and inability to actively extend the knee. Diagnosis and surgical planning can be established with radiograph, ultrasonography, or magnetic resonance imaging. Surgical repair is the mainstay of treatment, and there have been many recent advances in repair technique, optimal reconstruction strategies, and supplemental fixation. Time to surgery for complete tears remains the most important prognosticator for success. Direct primary repair can be completed with transosseous tunnels, suture anchor repair, or end-to-end repair. Tendon reconstruction can be achieved with or without mechanical or biologic augments. Rehabilitation programs vary in specifics, but return to sport can be expected by 6 months postoperatively.
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Affiliation(s)
- Joseph C. Brinkman
- From the Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ (Dr. Brinkman, Dr. Chhabra), and the Crieghton University School of Medicine, Phoenix, AZ (Ms. Reeson)
| | - Emily Reeson
- From the Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ (Dr. Brinkman, Dr. Chhabra), and the Crieghton University School of Medicine, Phoenix, AZ (Ms. Reeson)
| | - Anikar Chhabra
- From the Department of Orthopedic Surgery, Mayo Clinic, Phoenix, AZ (Dr. Brinkman, Dr. Chhabra), and the Crieghton University School of Medicine, Phoenix, AZ (Ms. Reeson)
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DeFoor MT, Cognetti DJ, Yuan TT, Sheean AJ. Treatment of Tendon Injuries in the Servicemember Population across the Spectrum of Pathology: From Exosomes to Bioinductive Scaffolds. Bioengineering (Basel) 2024; 11:158. [PMID: 38391644 PMCID: PMC10886250 DOI: 10.3390/bioengineering11020158] [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: 12/15/2023] [Revised: 01/28/2024] [Accepted: 01/31/2024] [Indexed: 02/24/2024] Open
Abstract
Tendon injuries in military servicemembers are one of the most commonly treated nonbattle musculoskeletal injuries (NBMSKIs). Commonly the result of demanding physical training, repetitive loading, and frequent exposures to austere conditions, tendon injuries represent a conspicuous threat to operational readiness. Tendon healing involves a complex sequence between stages of inflammation, proliferation, and remodeling cycles, but the regenerated tissue can be biomechanically inferior to the native tendon. Chemical and mechanical signaling pathways aid tendon healing by employing growth factors, cytokines, and inflammatory responses. Exosome-based therapy, particularly using adipose-derived stem cells (ASCs), offers a prominent cell-free treatment, promoting tendon repair and altering mRNA expression. However, each of these approaches is not without limitations. Future advances in tendon tissue engineering involving magnetic stimulation and gene therapy offer non-invasive, targeted approaches for improved tissue engineering. Ongoing research aims to translate these therapies into effective clinical solutions capable of maximizing operational readiness and warfighter lethality.
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Affiliation(s)
- Mikalyn T DeFoor
- San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
| | - Daniel J Cognetti
- San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
| | - Tony T Yuan
- Advanced Exposures Diagnostics, Interventions and Biosecurity Group, 59 Medical Wing, Lackland Air Force Base, San Antonio, TX 78236, USA
- Center for Biotechnology (4D Bio3), Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Andrew J Sheean
- San Antonio Military Medical Center, Fort Sam Houston, TX 78234, USA
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Llombart R, Mariscal G, Barrios C, Llombart-Ais R. The Best Current Research on Patellar Tendinopathy: A Review of Published Meta-Analyses. Sports (Basel) 2024; 12:46. [PMID: 38393266 PMCID: PMC10893258 DOI: 10.3390/sports12020046] [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: 12/16/2023] [Revised: 01/24/2024] [Accepted: 01/30/2024] [Indexed: 02/25/2024] Open
Abstract
Patellar tendinopathy is a frequent overuse injury in sports that can cause significant pain and disability. It requires evidence-based guidelines on effective prevention and management. However, optimal treatments remain uncertain. We aimed to analyze available meta-analyses to summarize treatment recommendations, compare therapeutic modalities, examine included trials, and offer methodological suggestions to improve future systematic reviews. Meta-analyses were systematically searched for in PubMed (PROSPERO: CRD42023457963). A total of 21 meta-analyses were included. The AMSTAR-2 scale assessed study quality, which was low, with only 23.8% of the meta-analyses being of moderate quality, and none were considered to be of high quality. Heterogeneous outcomes are reported. Multiple platelet-rich plasma (PRP) injections appear superior to eccentric exercises and provide lasting improvements compared to eccentric exercises when conservative treatments fail. Extracorporeal shockwave therapy (ESWT) also seems superior to non-operative options and similar to surgery for patellar tendinopathy in the long term. However, evidence for eccentric exercise efficacy remains unclear due to inconclusive findings. Preliminary findings also emerged for genetic risk factors and diagnostic methods but require further confirmation. This review reveals a lack of high-quality evidence on optimal patellar tendinopathy treatments. While PRP and ESWT show promise, limitations persist. Further rigorous meta-analyses and trials are needed to strengthen the evidence base and guide clinical practice. Methodological enhancements are proposed to improve future meta-analyses.
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Affiliation(s)
- Rafael Llombart
- Orthopedic Surgery Department, University Clinic of Navarra, 31008 Pamplona, Spain
| | - Gonzalo Mariscal
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain
| | - Carlos Barrios
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain
| | - Rafael Llombart-Ais
- Institute for Research on Musculoskeletal Disorders, School of Medicine, Valencia Catholic University, 46001 Valencia, Spain
- Traumacenter, Casa de Salud Hospital, 46021 Valencia, Spain
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Nelson PA, George T, Bowen E, Sheean AJ, Bedi A. An Update on Orthobiologics: Cautious Optimism. Am J Sports Med 2024; 52:242-257. [PMID: 38164688 DOI: 10.1177/03635465231192473] [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] [Indexed: 01/03/2024]
Abstract
Orthobiologics are rapidly growing in use given their potential to augment healing for multiple musculoskeletal conditions. Orthobiologics consist of a variety of treatments including platelet-rich plasma and stem cells that provide conceptual appeal in providing local delivery of growth factors and inflammation modulation. The lack of standardization in nomenclature and applications within the literature has led to a paucity of high-quality evidence to support their frequent use. The purpose of this review was to describe the current landscape of orthobiologics and the most recent evidence regarding their use.
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Affiliation(s)
- Patrick A Nelson
- University of Chicago Department of Orthopedic Surgery, Chicago, Illinois, USA
| | - Tom George
- Northshore University Healthcare System, Evanston, Illinois, USA
| | - Edward Bowen
- Weill Cornell Medicine, New York City, New York, USA
| | - Andrew J Sheean
- San Antonio Military Medical Center, Department of Orthopedic Surgery, San Antonio, Texas, USA
| | - Asheesh Bedi
- Northshore University Healthcare System, Evanston, Illinois, USA
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Walton J, Kozina E, Woo F, Jadidi S. A Review of Patellar Tendinopathy in Athletes Involved in Jumping Sports. Cureus 2023; 15:e47459. [PMID: 38022235 PMCID: PMC10661584 DOI: 10.7759/cureus.47459] [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: 10/21/2023] [Indexed: 12/01/2023] Open
Abstract
This review article discusses the anatomy and histopathology of the patellar tendon, as well as the risk factors and common interventions for patellar tendinopathy (PT) with a view to guide clinicians in treating athletes with patellar tendon pain. PT, or jumper's knee, refers to a chronic injury to the patellar tendon that affects athletes who engage in jumping and explosive movements. The condition is characterized by degeneration and disorganization of the collagen fibers in the tendon, an increase in mucoid ground substance, and fibroblast proliferation. Risk factors for patellar tendinopathy include participation in jumping sports, a greater counter-movement jump height, and training on hard surfaces. Nonoperative treatments for patellar tendinopathy include relative rest, stretching and strengthening exercises, and correction of biomechanical abnormalities. Surgery and other procedures, such as extracorporeal shockwave therapy (ESWT) and injection therapies, may be considered for patients who do not respond to conservative measures.
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Affiliation(s)
- John Walton
- Family and Community Medicine, McGaw Medical Center of Northwestern University, Chicago, USA
| | - Erik Kozina
- Orthopedics, University of Illinois at Chicago, Chicago, USA
| | - Frank Woo
- Internal Medicine and Pediatrics, Loyola University Medical Center, Chicago, USA
| | - Shaheen Jadidi
- Sports Medicine, Loyola University Medical Center, Chicago, USA
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Pretorius J, Habash M, Ghobrial B, Alnajjar R, Ellanti P. Current Status and Advancements in Platelet-Rich Plasma Therapy. Cureus 2023; 15:e47176. [PMID: 38021947 PMCID: PMC10652151 DOI: 10.7759/cureus.47176] [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: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Platelet-rich plasma (PRP) as a treatment modality has been around for the last four decades, but only truly gained popularity over the last 10 to 15 years in medicine, in a variety of fields ranging from regenerative medicine to infertility treatment. It has gained popularity, especially in treating musculoskeletal conditions where the bulk of research has been performed and published. There is level I evidence available supporting its efficacy in the treatment of osteoarthritis (OA), epicondylitis, bursitis, compressive neuropathy, plantar fasciitis, muscular injuries and osteochondral lesions. Most published research with regards to PRP has been focused on knee OA (limited research in shoulder, elbow, and foot and ankle OA), lateral epicondylitis and carpal tunnel syndrome, whereas spinal and hand conditions have limited research available. Tendinopathies and partial tendon tears have conflicting evidence available, with level I evidence supporting PRP's use in rotator cuff tendinopathies and tears, with contradictory level I evidence discouraging its use in patella and Achilles tendinopathies and tears. The available evidence regarding the use of PRP continues to produce conflicting results, but despite this, there is an ongoing increase in the popularity and use of PRP in patients with musculoskeletal conditions.
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Affiliation(s)
| | - Mohammed Habash
- Orthopaedics and Traumatology, University Hospital Galway, Galway, IRL
| | - Bishoy Ghobrial
- Trauma and Orthopaedics, University Hospital Galway, Galway, IRL
| | - Rafee Alnajjar
- Trauma and Orthopaedics, University Hospital Galway, Galway, IRL
| | - Prasad Ellanti
- Trauma and Orthopaedics, Letterkenny University Hospital, Letterkenny, IRL
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Sugrañes J, Jackson GR, Mameri ES, Schundler S, Obioha OA, Pascual TA, Chahla J. Current Concepts in Patellar Tendinopathy: An Overview of Imaging, Pathogenesis, and Nonoperative and Operative Management. JBJS Rev 2023; 11:01874474-202308000-00007. [PMID: 37590404 DOI: 10.2106/jbjs.rvw.23.00076] [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: 08/19/2023]
Abstract
» Approximately 1 in 3 high-impact athletes develops patellar tendinopathy (PT), with the proximal insertion of the patellar tendon being the most commonly affected anatomical site.» Nonoperative treatment options are effective in reducing pain and restoring functionality in most patients with PT. However, operative intervention should be considered when conservative management fails.» A comprehensive review of the literature on surgical procedures, including both open and arthroscopic approaches, was conducted with a specific focus on clinical outcomes and return to sports.» Both open surgery and arthroscopic surgery for PT have demonstrated favorable success rates and return-to-sport outcomes, with arthroscopic treatment potentially expediting the recovery process.
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Affiliation(s)
- Joan Sugrañes
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- Department of Orthopaedics and Traumatology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Garrett R Jackson
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Enzo S Mameri
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
- Department of Orthopaedics and Traumatology, Escola Paulista de Medicina, Federal University of São Paulo, São Paulo, Brazil
| | - Sabrina Schundler
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Obianuju A Obioha
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
| | - Tomás A Pascual
- Department of Radiology, HIMAN Barrio Norte, Buenos Aires, Argentina
| | - Jorge Chahla
- Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, Illinois
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Stewart ZE, Lee K. Lower extremity ultrasound-guided interventions: tendon, ligament, and plantar fascia. Skeletal Radiol 2023; 52:991-1003. [PMID: 36326878 DOI: 10.1007/s00256-022-04212-4] [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: 09/14/2022] [Revised: 10/14/2022] [Accepted: 10/17/2022] [Indexed: 11/06/2022]
Abstract
Lower extremity tendinopathy and soft tissue injury are common clinical problems that can cause significant disability. Ultrasound-guided minimally invasive treatments using orthobiologics and image-guided percutaneous treatments continue to gain relevance with an ever-growing body of literature. We review the indications, technique, risks, and benefits according to the literature of common ultrasound-guided interventions utilized in the lower extremities.
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Affiliation(s)
- Zachary E Stewart
- Department of Radiology - Musculoskeletal Imaging and Intervention, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, Yawkey Bldg Room 6033, Boston, MA, 02114, USA.
| | - Kenneth Lee
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Creating an Optimal In Vivo Environment to Enhance Outcomes Using Cell Therapy to Repair/Regenerate Injured Tissues of the Musculoskeletal System. Biomedicines 2022; 10:biomedicines10071570. [PMID: 35884875 PMCID: PMC9313221 DOI: 10.3390/biomedicines10071570] [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] [Received: 03/24/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Following most injuries to a musculoskeletal tissue which function in unique mechanical environments, an inflammatory response occurs to facilitate endogenous repair. This is a process that usually yields functionally inferior scar tissue. In the case of such injuries occurring in adults, the injury environment no longer expresses the anabolic processes that contributed to growth and maturation. An injury can also contribute to the development of a degenerative process, such as osteoarthritis. Over the past several years, researchers have attempted to use cellular therapies to enhance the repair and regeneration of injured tissues, including Platelet-rich Plasma and mesenchymal stem/medicinal signaling cells (MSC) from a variety of tissue sources, either as free MSC or incorporated into tissue engineered constructs, to facilitate regeneration of such damaged tissues. The use of free MSC can sometimes affect pain symptoms associated with conditions such as OA, but regeneration of damaged tissues has been challenging, particularly as some of these tissues have very complex structures. Therefore, implanting MSC or engineered constructs into an inflammatory environment in an adult may compromise the potential of the cells to facilitate regeneration, and neutralizing the inflammatory environment and enhancing the anabolic environment may be required for MSC-based interventions to fulfill their potential. Thus, success may depend on first eliminating negative influences (e.g., inflammation) in an environment, and secondly, implanting optimally cultured MSC or tissue engineered constructs into an anabolic environment to achieve the best outcomes. Furthermore, such interventions should be considered early rather than later on in a disease process, at a time when sufficient endogenous cells remain to serve as a template for repair and regeneration. This review discusses how the interface between inflammation and cell-based regeneration of damaged tissues may be at odds, and outlines approaches to improve outcomes. In addition, other variables that could contribute to the success of cell therapies are discussed. Thus, there may be a need to adopt a Precision Medicine approach to optimize tissue repair and regeneration following injury to these important tissues.
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