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  • 28.07.2016
    The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy

    The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy

    A Meta-analysis of Randomized Controlled Clinical Trials

    1.Jane Fitzpatrick, MBBS, FACSP*,2.,Max Bulsara, BSc(Hons), MSc, PhD and 3. Ming H. Zheng, MD, PhD, FRCPath, FRCPA

    1.University of Western Australia, Perth, Australia,  2.‡University of Notre Dame Australia, Freemantle, Australia, 3.*Jane Fitzpatrick, MBBS, FACSP, University of Western Australia, 35 Stirling Highway, M508 Crawley, WA, 6009 Australia (email: jane.fitzpatrick@research.uwa.edu.au).

    Abstract

    Background: Tendinopathy is very common in the general population. There are increasing numbers of clinical studies referring to platelet-rich plasma (PRP) and platelet-poor plasma (PPP) as treatments for tendinopathy.

    Purpose: To perform a meta-analysis of the outcomes of the PRP groups by preparation method and injection technique in tendinopathy. To determine the clinical effectiveness of the preparations and to evaluate the effect of controls used in the studies reviewed.

    Study Design: Systematic review and meta-analysis.

    Methods: The PubMed, EMBASE, CINAHL, and Medline databases were searched in March 2012, April 2014, and August 2015, and randomized controlled trials using autologous blood, PRP, PPP, or autologous conditioned plasma in tendinopathy with outcome measures of pain and follow-up time of 3 months were included in this review. Trials including surgery, tendon tears, and muscle or ligament injuries were excluded. Study quality was assessed using the Cochrane Collaboration risk-of-bias tool by 2 reviewers. Data were pooled using random-effects meta-analysis. The primary outcome measure was a change in pain intensity. Where more than 1 pain scale was included, a functional score was selected ahead of a visual analog scale score.

    Results: A total of 18 studies (1066 participants) were included. Eight studies were deemed to be at low risk of bias. The most significant outcomes in the PRP groups were seen in those treated with highly cellular leukocyte-rich PRP (LR-PRP) preparations: GPS kit (standardized mean difference [SMD], 35.75; 95% CI, 28.40-43.10), MyCells kit (SMD, 31.84; 95% CI, 17.56-46.13), Prosys kit (SMD, 42.99; 95% CI, 37.73-48.25), and unspecified LR-PRP (SMD, 34.62; 95% CI, 31.69-37.55). When the LR-PRP system types were grouped, there was a strongly positive effect (SMD, 36.38; 95% CI, 34.00-38.77) when compared with leukocyte-poor PRP (SMD, 26.77; 95% CI, 18.31-35.22). In assessing the control groups, there was no clear difference between different types of control injections: saline (SMD, 14.62; 95% CI, 10.74-18.50), local anesthetic (SMD, 15.00; 95% CI, 7.66-22.34), corticosteroid (SMD, 23.82; 95% CI, 10.74-18.50), or dry needling (SMD, 25.22; 95% CI, 21.27-29.16).

    Conclusion: There is good evidence to support the use of a single injection of LR-PRP under ultrasound guidance in tendinopathy. Both the preparation and intratendinous injection technique of PRP appear to be of great clinical significance.

    Keywords: platelet-rich plasma, tendinitis, tendinopathy, platelet separation system, meta-analysis, injection therapy

    Footnotes

    The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

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Viimeisimmät uutiset

  • 28.07.2016
    The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy

    The Effectiveness of Platelet-Rich Plasma in the Treatment of Tendinopathy

    A Meta-analysis of Randomized Controlled Clinical Trials

    1.Jane Fitzpatrick, MBBS, FACSP*,2.,Max Bulsara, BSc(Hons), MSc, PhD and 3. Ming H. Zheng, MD, PhD, FRCPath, FRCPA

    1.University of Western Australia, Perth, Australia,  2.‡University of Notre Dame Australia, Freemantle, Australia, 3.*Jane Fitzpatrick, MBBS, FACSP, University of Western Australia, 35 Stirling Highway, M508 Crawley, WA, 6009 Australia (email: jane.fitzpatrick@research.uwa.edu.au).

    Abstract

    Background: Tendinopathy is very common in the general population. There are increasing numbers of clinical studies referring to platelet-rich plasma (PRP) and platelet-poor plasma (PPP) as treatments for tendinopathy.

    Purpose: To perform a meta-analysis of the outcomes of the PRP groups by preparation method and injection technique in tendinopathy. To determine the clinical effectiveness of the preparations and to evaluate the effect of controls used in the studies reviewed.

    Study Design: Systematic review and meta-analysis.

    Methods: The PubMed, EMBASE, CINAHL, and Medline databases were searched in March 2012, April 2014, and August 2015, and randomized controlled trials using autologous blood, PRP, PPP, or autologous conditioned plasma in tendinopathy with outcome measures of pain and follow-up time of 3 months were included in this review. Trials including surgery, tendon tears, and muscle or ligament injuries were excluded. Study quality was assessed using the Cochrane Collaboration risk-of-bias tool by 2 reviewers. Data were pooled using random-effects meta-analysis. The primary outcome measure was a change in pain intensity. Where more than 1 pain scale was included, a functional score was selected ahead of a visual analog scale score.

    Results: A total of 18 studies (1066 participants) were included. Eight studies were deemed to be at low risk of bias. The most significant outcomes in the PRP groups were seen in those treated with highly cellular leukocyte-rich PRP (LR-PRP) preparations: GPS kit (standardized mean difference [SMD], 35.75; 95% CI, 28.40-43.10), MyCells kit (SMD, 31.84; 95% CI, 17.56-46.13), Prosys kit (SMD, 42.99; 95% CI, 37.73-48.25), and unspecified LR-PRP (SMD, 34.62; 95% CI, 31.69-37.55). When the LR-PRP system types were grouped, there was a strongly positive effect (SMD, 36.38; 95% CI, 34.00-38.77) when compared with leukocyte-poor PRP (SMD, 26.77; 95% CI, 18.31-35.22). In assessing the control groups, there was no clear difference between different types of control injections: saline (SMD, 14.62; 95% CI, 10.74-18.50), local anesthetic (SMD, 15.00; 95% CI, 7.66-22.34), corticosteroid (SMD, 23.82; 95% CI, 10.74-18.50), or dry needling (SMD, 25.22; 95% CI, 21.27-29.16).

    Conclusion: There is good evidence to support the use of a single injection of LR-PRP under ultrasound guidance in tendinopathy. Both the preparation and intratendinous injection technique of PRP appear to be of great clinical significance.

    Keywords: platelet-rich plasma, tendinitis, tendinopathy, platelet separation system, meta-analysis, injection therapy

    Footnotes

    The authors declared that they have no conflicts of interest in the authorship and publication of this contribution.

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  • 28.07.2016
    Platelet-Rich Plasma Obtained with Different Anticoagulants and Their Effect on Platelet Numbers and Mesenchymal Stromal Cells Behavior In Vitro

    Platelet-Rich Plasma Obtained with Different Anticoagulants and Their Effect on Platelet Numbers and Mesenchymal Stromal Cells Behavior In Vitro

    Ronaldo José Farias Corrêa do Amaral,1,2 Nemias Pereira da Silva,1 Natália Ferreira Haddad,1 Luana Siqueira Lopes,1 Fábio Dias Ferreira,1 Ricardo Bastos Filho,3 Paola Alejandra Cappelletti,1 Wallace de Mello,1,4 Eric Cordeiro-Spinetti,2 and Alex Balduino1,2

    1Excellion Serviços Biomédicos, Amil/UnitedHealth Group, 25651-000 Petrópolis, RJ, Brazil
    2Laboratório de Biologia e Tecnologia Celular, Universidade Veiga de Almeida, 20270-150 Rio de Janeiro, RJ, Brazil
    3Universidade Federal Fluminense, 24033-900 Niterói, RJ, Brazil
    4Centro Universitário Celso Lisboa, 20950-091 Rio de Janeiro, RJ, Brazil

    Received 8 January 2016; Revised 9 April 2016; Accepted 27 April 2016

    Academic Editor: Jiabing Fan

    Copyright © 2016 Ronaldo José Farias Corrêa do Amaral et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


    Abstract

    There are promising results in the use of platelet-rich plasma (PRP) for musculoskeletal tissue repair. However, the variability in the methodology for its obtaining may cause different and opposing findings in the literature. Particularly, the choice of the anticoagulant is the first definition to be made. In this work, blood was collected with sodium citrate (SC), ethylenediaminetetraacetic acid (EDTA), or anticoagulant citrate dextrose (ACD) solution A, as anticoagulants, prior to PRP obtaining. Hematological analysis and growth factors release quantification were performed, and the effects on mesenchymal stromal cell (MSC) culture, such as cytotoxicity and cell proliferation (evaluated by MTT method) and gene expression, were evaluated. The use of EDTA resulted in higher platelet yield in whole blood; however, it induced an increase in the mean platelet volume (MPV) following the blood centrifugation steps for PRP obtaining. The use of SC and ACD resulted in higher induction of MSC proliferation. On the other hand, PRP obtained in SC presented the higher platelet recovery after the blood first centrifugation step and a minimal change in MSC gene expression. Therefore, we suggest the use of SC as the anticoagulant for PRP obtaining.

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  • 29.04.2016
    GLOFINN Distributor Meeting on 12th-13th of May 2016 Barcelona, Spain

    We are happy to announce that the GloFinn Distributor Meeting is going to take place in Barcelona, Spain thu-fri 12th-13th of May.

    The Venue for the Meeting is Best Western Hotel Mediterraneo.

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