Int Orthop. 2012 Dec 19. [Epub ahead
of print]
Platelet-rich plasma injections for chronic plantar fasciitis.
Martinelli N,
Marinozzi A,
Carnì S,
Trovato U,
Bianchi A,
Denaro V.
Source
Department of Ankle and Foot Surgery, IRCCS Galeazzi, via R. Galeazzi 4,
20100, Milan, Italy, n.martinelli@unicampus.it.
Abstract
PURPOSE:
The purpose of this study was to assess the safety and preliminary
clinical results of platelet-rich plasma (PRP) injections for treating chronic
plantar fasciitis.
METHODS:
Fourteen consecutive patients with chronic plantar fasciitis receiving
three injections of PRP into the plantar fascia were assessed 12 months after
the procedure. The modified Roles and Maudsley score and a visual analogue scale
(VAS) for pain were used to evaluate the clinical results.
RESULTS:
According to criteria of the Roles and Maudsley score, at 12 months of
follow-up, results were rated as excellent in nine (64.3 %), good in two (14.3
%), acceptable in two (14.3 %) and poor in one (7.1 %) patient. VAS for pain was
significantly decreased from 7.1 ± 1.1 before treatment to 1.9 ± 1.5 at the last
follow-up (p < 0.01).
CONCLUSIONS:
In this single-centre, uncontrolled, prospective, preliminary study,
results indicate that treating chronic plantar fasciitis with PRP injections is
safe and has the potential to reduce pain.
PMID:
23250352
[PubMed - as supplied by publisher]
J Orthop Res. 2012 Oct;30(10):1570-6. doi: 10.1002/jor.22118. Epub 2012 Apr 9.
Efficacy of platelet-rich plasma combined with allograft bone in the management of displaced intra-articular calcaneal fractures: a prospective cohort study.
Wei LC,
Lei GH,
Sheng PY,
Gao SG,
Xu M,
Jiang W,
Song Y,
Luo W.
Source
Department of Orthopedics, XiangYa Hospital, Central South University, 87 XiangYa Road, Changsha, Hunan 410008, China.
Abstract
To investigate whether platelet-rich plasma (PRP) when used with allograft bone improves the management outcome of displaced intra-articular calcaneal fractures. Over a 7-year period, all displaced type III calcaneal fractures admitted in our department (276 fractures in 254 patients) were randomly divided into three groups according to the plan of management: autograft alone (n = 101), allograft combined with PRP (n = 85), or allograft alone (n = 90). Radiographic imaging and three-dimensional computed tomography were used to assess the thalamic portion, Bohler's angle, the crucial angle of Gissane, and the height, width and length of the calcaneum. The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind-foot scoring system was used to evaluate the hind foot function at 12, 24, and 72 months postsurgery. At 12 months no significant difference existed in outcome amongst the treatment groups (p > 0.05). However, at 24 and 72 months the results of the autograft, and the allograft combined with PRP, were similar and both were significantly better than that of the allograft alone (p < 0.05). PRP augmented the favorable outcome of allografts in the management of displaced calcaneal fractures, and matched that of autograft used alone. The findings of this study thus support the clinical use of PRP in conjunction with allograft in the treatment of displaced intra-articular calcaneal fractures.
Copyright © 2012 Orthopaedic Research Society.
PMID:
22488880
[PubMed - indexed for MEDLINE]
Comparison of Surgically Repaired Achilles Tendon Tears Using Platelet-Rich Fibrin Matrices
Mikel Sánchez,* MD, Eduardo Anitua,† MD, DDS, Juan Azofra,* MD, Isabel Andía,† PhD, Sabino Padilla,‡ MD, PhD, and Iñigo Mujika,‡§ PhD
From the *Arthroscopic Surgery Unit, USP–La Esperanza Clinic, Vitoria-Gasteiz, Basque Country, Spain, the †BTI Biotechnology Institute, Vitoria-Gasteiz, Basque Country, Spain,
and the ‡Department of Research and Development, Medical Services, Athletic Club Bilbao, Basque Country, Spain
Background: Platelet-rich fibrin matrices release a natural mixture of growth factors that play central roles in the complex processes of tendon healing.
Hypothesis: Application of autologous platelet-rich matrices during Achilles tendon surgery may promote healing and functional recovery.
Study Design: Case-control study and descriptive laboratory study; Level of evidence, 3.
Methods: Twelve athletes underwent open suture repair after complete Achilles tendon tear. Open suture repair in conjunction with a preparation rich in growth factors (PRGF) was performed in 6 athletes and retrospectively compared with a matched group that followed conventional surgical procedure. The outcomes were evaluated on the basis of range of motion, functional recovery, and complications. Achilles tendons were examined by ultrasound at 50 ± 11 months in retrospective controls and 32 ± 10 months in the PRGF group. In the laboratory portion of the study, PRGF treatment was characterized by the number of platelets and concen- tration of insulin (IGF-I), transformed (TGF-β1), platelet-derived (PDGF-AB), vascular endothelial (VEGF), hepatocyte (HGF), and epi- dermal (EGF) growth factors in patients affected by musculoskeletal traumatic injuries.
Results: Athletes receiving PRGF recovered their range of motion earlier (7 ± 2 weeks vs 11 ± 3 weeks, P = .025), showed no wound complication, and took less time to take up gentle running (11 ± 1 weeks vs 18 ± 3 weeks, P = .042) and to resume training activi- ties (14 ± 0.8 weeks vs 21 ± 3 weeks, P = .004). The cross-sectional area of the PRGF-treated tendons increased less (t = 3.44, P = .009). TGF-β1 (74.99 ± 32.84 ng/mL), PDGF-AB (35.62 ± 14.57 ng/mL), VEGF (383.9 ± 374.9 pg/mL), EGF (481.5 ± 187.5 pg/mL), and HGF (593.87 ± 155.76 pg/mL) significantly correlated with the number of platelets (677 ± 217 platelets/μL, P < .05).
Conclusion: The operative management of tendons combined with the application of autologous PRGF may present new possi- bilities for enhanced healing and functional recovery. This needs to be evaluated in a randomized clinical trial.
Keywords: sports; platelets; growth factors; surgical repair; Achilles tendon
Plasma Rich in Growth Factors to Treat an Articular Cartilage Avulsion: A Case Report
MIKEL SANCHEZ1, JUAN AZOFRA1, EDUARDO ANITUA2, ISABEL ANDIA3, SABINO PADILLA4, JUANMA SANTISTEBAN4, and INIGO MUJIKA4
1Arthroscopic Surgery Unit, USP-La Esperanza Clinic, Vitoria-Gasteiz, Basque Country, SPAIN; 2B.T.I. Biotechnology Institute, Vitoria-Gasteiz, Basque Country, SPAIN; 3Department of Neurochemistry Research, Osakidetza–Basque Health Service, Zamudio, Basque Country, SPAIN; and 4Department of Research and Development, Medical Services, Athletic Club of Bilbao, Basque Country, SPAIN
ABSTRACT
SANCHEZ, M., J. AZOFRA, E. ANITUA, I. ANDIA, S. PADILLA, J. SANTISTEBAN, and I. MUJIKA. Plasma Rich in Growth Factors to Treat an Articular Cartilage Avulsion: A Case Report. Med. Sci. Sports Exerc., Vol. 35, No. 10, pp. 1648–1652, 2003.
Introduction: The application of an autologous plasma rich in growth factors is beneficial in restoring connective tissues, as shown by clinical evidence in oral surgery and more recently in arthroscopic anterior cruciate ligament reconstruction and two cases of ruptured Achilles tendon in professional athletes. This is attributed to the slow delivery of growth factors from harvested platelets that have been activated by endogenous thrombin promoted by the addition of calcium chloride.
Purpose: This case report describes a new application of this therapy in the arthroscopic treatment of a large, nontraumatic avulsion of articular cartilage in the knee of an adolescent soccer player.
Methods: After arthroscopic reattachment of the large (2 cm) loose chondral body in its crater in the medial femoral condyle, autologous plasma rich in growth factors was injected into the area between the crater and the fixed fragment.
Results and Conclusion: Despite the extremely poor prognosis of the case, complete articular cartilage healing was considerably accelerated, and the functional outcome was excellent, allowing a rapid resumption of symptom-free athletic activity. This technique opens new perspectives for human tissue regeneration. Key Words: PRGF, KNEE ARTHROSCOPY, TISSUE REGENERATION, FUNCTIONAL RECOVERY