|
1
|
Mahajan U, Papaleontiou A, Imam MA, Mahmood A. Assessing Standardisation in Platelet-Rich Plasma (PRP) Injections for the Management of Greater Trochanteric Pain Syndrome (GTPS): A Systematic Review of the Available Literature. Cureus 2024; 16:e74690. [PMID: 39734950 PMCID: PMC11681989 DOI: 10.7759/cureus.74690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2024] [Indexed: 12/31/2024] Open
Abstract
Greater trochanteric pain syndrome (GTPS) is a prevalent musculoskeletal condition characterised by lateral hip pain and reduced function. Platelet-rich plasma (PRP) injections have gained attention as a potential treatment due to their regenerative properties. However, variability in PRP preparation methods and insufficient standardisation in the literature complicate the evaluation of its efficacy and reproducibility. This systematic review aims to assess the level of standardisation in PRP injection protocols for GTPS, focusing on preparation methods, injection techniques, and reported outcomes. A systematic review was conducted using comprehensive searches of major databases. Inclusion criteria targeted randomised controlled trials (RCTs) evaluating PRP for GTPS in adults. Four eligible RCTs were identified, and data were extracted on PRP preparation methods, injection protocols, and reported outcomes. The risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. The included studies demonstrated significant heterogeneity in PRP preparation methods, including centrifugation speeds (1,100 gravitational force (g) to 3,850 revolutions per minute (rpm)), blood volumes (25-54 mL), and platelet concentrations (9.23 × 10⁹/L to 1232 × 10⁹/L). Injection sites varied from the gluteal tendons to the trochanteric bursa, with volumes ranging from 4 mL to 7 mL. Only one study conducted ultrasound-guided injections into the tendon. Despite the variability, two studies reported significant improvements in pain and function, while two found no difference compared to the control. This review highlights the lack of standardisation in PRP preparation and injection protocols for GTPS. Standardised guidelines are urgently needed to improve comparability across studies and optimise clinical outcomes. Future research should establish consensus on PRP preparation, classification, and reporting standards to advance its clinical application.
Collapse
Affiliation(s)
- Uday Mahajan
- Trauma and Orthopaedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
| | | | - Mohamed A Imam
- Trauma and Orthopaedics, Trauma Surgery, Ashford and St Peter's Hospitals NHS Foundation Trust, Ashford, GBR
| | - Ansar Mahmood
- Trauma and Orthopaedics, Queen Elizabeth Hospital Birmingham, Birmingham, GBR
| |
Collapse
|
|
2
|
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.
Collapse
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
| |
Collapse
|
|
3
|
Peña AN, Sommerfeld SD, Anderson AE, Han J, Maestas DR, Mejias JC, Woodell-May J, King W, Ganguly S, Elisseeff JH. Autologous Protein Solution processing alters lymphoid and myeloid cell populations and modulates gene expression dependent on cell type. Arthritis Res Ther 2022; 24:221. [PMID: 36096945 PMCID: PMC9465964 DOI: 10.1186/s13075-022-02875-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
Osteoarthritis (OA) is a degenerative disease associated with cartilage degradation, osteophyte formation, and fibrillation. Autologous Protein Solution (APS), a type of autologous anti-inflammatory orthobiologic, is used for pain management and treatment of OA. Various compositions of autologous PRP formulations are in clinical use for musculoskeletal pathologies, by nature of their minimal processing and source of bioactive molecules. Currently, there is no consensus on the optimal composition of the complex mixture. In this study, we focused on elucidating the immune cell subtypes and phenotypes in APS. We identified the immune cell types in APS from healthy donors and investigated phenotypic changes in the immune cells after APS processing. Based on flow cytometric analysis, we found that neutrophils and T cells are the most abundant immune cell types in APS, while monocytes experience the largest fold change in concentration compared to WBCs. Gene expression profiling revealed that APS processing results in differential gene expression changes dependent on immune cell type, with the most significantly differentially regulated genes occurring in the monocytes. Our results demonstrate that the mechanical processing of blood, whose main purpose is enrichment and separation, can alter its protein and cellular composition, as well as cellular phenotypes in the final product.
Collapse
Affiliation(s)
- Alexis N Peña
- Translational Tissue Engineering Center, Johns Hopkins University, 400 N. Broadway Smith Building 5th floor, Baltimore, MD, 21231, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Sven D Sommerfeld
- Translational Tissue Engineering Center, Johns Hopkins University, 400 N. Broadway Smith Building 5th floor, Baltimore, MD, 21231, USA
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Amy E Anderson
- Translational Tissue Engineering Center, Johns Hopkins University, 400 N. Broadway Smith Building 5th floor, Baltimore, MD, 21231, USA
- Department of Cellular and Molecular Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jin Han
- Translational Tissue Engineering Center, Johns Hopkins University, 400 N. Broadway Smith Building 5th floor, Baltimore, MD, 21231, USA
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - David R Maestas
- Translational Tissue Engineering Center, Johns Hopkins University, 400 N. Broadway Smith Building 5th floor, Baltimore, MD, 21231, USA
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | - Joscelyn C Mejias
- Translational Tissue Engineering Center, Johns Hopkins University, 400 N. Broadway Smith Building 5th floor, Baltimore, MD, 21231, USA
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA
| | | | - William King
- Zimmer Biomet, 56 East Bell Drive, Warsaw, IN, 46581, USA
| | - Sudipto Ganguly
- Bloomberg~Kimmel Institute for Cancer Immunotherapy and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Oncology and Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jennifer H Elisseeff
- Translational Tissue Engineering Center, Johns Hopkins University, 400 N. Broadway Smith Building 5th floor, Baltimore, MD, 21231, USA.
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD, USA.
- Wilmer Eye Institute, Johns Hopkins University, Baltimore, MD, USA.
| |
Collapse
|
|
4
|
Machado ES, Soares FP, Yamaguchi RS, Felipone WK, Meves R, Souza TAC, Topolniak R, Caldas JP, Abreu EV, Rabelo Neto LS, Pinchemel PVS, Bredemeier M. A Simple Double-Spin Closed Method for Preparing Platelet-Rich Plasma. Cureus 2022; 14:e20899. [PMID: 35145803 PMCID: PMC8807432 DOI: 10.7759/cureus.20899] [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: 01/01/2022] [Indexed: 11/07/2022] Open
Abstract
Objective: To describe and analyze a new protocol for the extraction of platelet-rich plasma (PRP) for use in clinical practice and compare this technique with methods that have been previously described in the medical literature. Methods: Sixteen blood samples from healthy volunteers were collected. PRP was prepared using our new double-spin technique, consisting of successive centrifugation of blood samples with two different spins, without opening the container. Descriptive analysis of cell counts in baseline and PRP samples was undertaken. Comparison between cell and platelet count in baseline and PRP samples, as well as the statistical analysis, were done. Results: The mean platelet concentration ratio was 3.47 (SD: 0.85; 95% CI: 3.01-3.92; range: 2.48-5.71). The baseline whole blood platelet count correlated positively to the PRP platelet count (rP = 0.56; 95% CI: 0.09-0.88; P = 0.023). The PRP was enriched for lymphocytes and monocytes but presented significantly lower counts of neutrophils and eosinophils in comparison to baseline. Conclusion: Results show a safe and easily reproducible method to obtain PRP for use in clinical daily practice.
Collapse
|