BloodCure
By Alan Mishra
Information about Regenerative Medicine, Stem Cells, Platelet Rich Plasma and Sports Medicine
Wednesday, August 06, 2014
Biologic Orthopedic Society
The Biologic Orthopedic Society (BOS) is a group of professionals dedicated to the research and development of biologic treatments for musculoskeletal injuries and disorders. This group has now grown to over 2500 members worldwide. Much of the group's focus has been on the use of platelet rich plasma, stem cells and bone marrow concentrate (BMC) for tendonitis, arthritis and degenerative spinal disc disease.
The growth of the Biologic Orthopedic Society (BOS) is a testimony to the rapidly rising interest in biologic solutions to difficult musculoskeletal problems. Significant progress has been made in terms of better published data supporting the use of biologic therapies in the last 2-3 years. Clearly, more information and research is still needed. As the group continues to grown, more and more connections are being made. Ideas and projects are advancing. All of this should give hope to those patients in search of better treatments. Many hard working professionals are striving to deliver better biologic options.
I'll predict within another 5-10 years, we will be staggered by how much will be accomplished.
Sunday, August 03, 2014
Hamstring Injuries Treated with Platelet Rich Plasma Return to Play Faster than Rehab Alone
Hamstring muscle injuries are very common in a variety of sports including track, soccer, football and basketball. A recently published study in the American Journal of Sports Medicine (AJSM) found athletes that were treated with platelet rich plasma (PRP) injections returned faster to their sport when compared to rehabilitation alone. In the study, the PRP patients returned at an average of 26.7 days compared to 42.5 days in the control group (P = .02). (reference) This greater than two week difference in time to return to play after this common injury is clinically and competitively important.
Another recently published in the New England Journal of Medicine (NEJM) found no difference between PRP injections (2 injections spaced about a week apart) and a control group. Interestingly, both groups in this study returned to play at 42 days, very similar to the control group in the AJSM study. (reference)
Why are these results conflicting?
One important difference between the two studies is the type of PRP used to treat the patients. In the study that did show a difference, white blood cell enriched PRP (leukocyte enriched PRP) was used. In the study that did not show a difference, white blood cell poor PRP (leukocyte poor PRP) was used. This is a clear example of why PRP formulation matters.
The data published in elite, peer reviewed journals suggests leukocyte enriched PRP helps return athletes more than two weeks faster than rehabilitation alone after an acute hamstring injury. No difference in return to play can be expected if leukocyte poor PRP is used in this patient population.
As PRP and other cell therapies continue to evolve, it will become increasingly clear that formulations much match indication. Patients, researchers, and clinicians need to realize not all PRP is the same.
July 02, 2014
Fat Stem Cells help Knee Arthritis
Knee Arthritis is a very difficult problem to solve. Millions of patients suffer daily from this progressive disease state. A variety of novel biologic therapies are in development.
Stem cells can come from a variety of sources including your own fat. These cells are known as adipose derived stem cells. A recent study from Korea suggests there is value using this type of cell for knee arthritis. Researchers gave patients escalating dose of the cells and found the high dose resulted in improved pain and function scores. They also found the cartilage defect defect size decreased while the volume of cartilage in the knee increased.
Fat Derived Stem Cells
This data is encouraging and will need to be repeated prior to broad clinical use. (See abstract below)
For patients with this problem, the horizon is bright with many potential options like stem cells from your own fat.
Stem Cells. 2014 May;32(5):1254-66. doi: 10.1002/stem.1634.
Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof-of-concept clinical trial.
Jo CH1, Lee YG, Shin WH, Kim H, Chai JW, Jeong EC, Kim JE, Shim H, Shin JS, Shin IS, Ra JC, Oh S, Yoon KS.
Author information
Abstract
Mesenchymal stem cells (MSCs) are known to have a potential for articular cartilage regeneration. However, most studies focused on focal cartilage defect through surgical implantation. For the treatment of generalized cartilage loss in osteoarthritis, an alternative delivery strategy would be more appropriate. The purpose of this study was to assess the safety and efficacy of intra-articular injection of autologous adipose tissue derived MSCs (AD-MSCs) for knee osteoarthritis. We enrolled 18 patients with osteoarthritis of the knee and injected AD MSCs into the knee. The phase I study consists of three dose-escalation cohorts; the low-dose (1.0 × 10(7)cells), mid-dose (5.0 × 10(7)), and high-dose (1.0 × 10(8)) group with three patients each. The phase II included nine patients receiving the high-dose. The primary outcomes were the safety and the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) at 6 months. Secondary outcomes included clinical, radiological, arthroscopic, and histological evaluations. There was no treatment-related adverse event. The WOMAC score improved at 6 months after injection in the high-dose group. The size of cartilage defect decreased while the volume of cartilage increased in the medial femoral and tibial condyles of the high-dose group. Arthroscopy showed that the size of cartilage defect decreased in the medial femoral and medial tibial condyles of the high-dose group. Histology demonstrated thick, hyaline-like cartilage regeneration. These results showed that intra-articular injection of 1.0 × 10(8) AD MSCs into the osteoarthritic knee improved function and pain of the knee joint without causing adverse events, and reduced cartilage defects by regeneration of hyaline-like articular cartilage.
Tuesday, June 24, 2014
Platelet Rich Plasma Helps for "High" Ankle Sprains
"High" ankle sprains are significant injuries that typically result in prolonged recovery and time away from sports. This type of injury involves the strong ligaments that connect two of the major bones of the ankle. They are also known as syndesmotic injuries.
A recent randomized, controlled trial found that athletes that were treated with ultrasonic guided injections returned to play faster and has less pain than a control group. Return to play was almost 20 days faster for the PRP group. (40.8 days vs 59.6 days, p = 0.006) (See abstract below)
This data supports the use of PRP for athletes with this type of injury. Further studies will help confirm this value.
Knee Surg Sports Traumatol Arthrosc. 2014 Jun 18. [Epub ahead of print]
Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial.
Laver L1, Carmont MR, McConkey MO, Palmanovich E, Yaacobi E, Mann G, Nyska M, Kots E, Mei-Dan O.
Author information
Abstract
PURPOSE:
Syndesmotic sprains are uncommon injuries that require prolonged recovery. The influence of ultrasound-guided injections of platelet-rich plasma (PRP) into the injured antero-inferior tibio-fibular ligaments (AITFL) in athletes on return to play (RTP) and dynamic stability was studied.
METHODS:
Sixteen elite athletes with AITFL tears were randomized to a treatment group receiving injections of PRP or to a control group. All patients followed an identical rehabilitation protocol and RTP criteria. Patients were prospectively evaluated for clinical ability to return to full activity and residual pain. Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome.
RESULTS:
All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion-external rotation, and larger neutral tibia-fibula distance on ultrasound. Early diagnosis and treatment lead to shorter RTP, with 40.8 (±8.9) and 59.6 (±12.0) days for the PRP and control groups, respectively (p = 0.006). Significantly less residual pain upon return to activity was found in the PRP group; five patients (62.5 %) in the control group returned to play with minor discomfort versus one patient in the treatment group (12.5 %). One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction.
CONCLUSIONS:
Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP, re-stabilization of the syndesmosis joint and less long-term residual pain. LEVEL OF EVIDENCE: II.
By Alan Mishra
Information about Regenerative Medicine, Stem Cells, Platelet Rich Plasma and Sports Medicine
Wednesday, August 06, 2014
Biologic Orthopedic Society
The Biologic Orthopedic Society (BOS) is a group of professionals dedicated to the research and development of biologic treatments for musculoskeletal injuries and disorders. This group has now grown to over 2500 members worldwide. Much of the group's focus has been on the use of platelet rich plasma, stem cells and bone marrow concentrate (BMC) for tendonitis, arthritis and degenerative spinal disc disease.
The growth of the Biologic Orthopedic Society (BOS) is a testimony to the rapidly rising interest in biologic solutions to difficult musculoskeletal problems. Significant progress has been made in terms of better published data supporting the use of biologic therapies in the last 2-3 years. Clearly, more information and research is still needed. As the group continues to grown, more and more connections are being made. Ideas and projects are advancing. All of this should give hope to those patients in search of better treatments. Many hard working professionals are striving to deliver better biologic options.
I'll predict within another 5-10 years, we will be staggered by how much will be accomplished.
Sunday, August 03, 2014
Hamstring Injuries Treated with Platelet Rich Plasma Return to Play Faster than Rehab Alone
Hamstring muscle injuries are very common in a variety of sports including track, soccer, football and basketball. A recently published study in the American Journal of Sports Medicine (AJSM) found athletes that were treated with platelet rich plasma (PRP) injections returned faster to their sport when compared to rehabilitation alone. In the study, the PRP patients returned at an average of 26.7 days compared to 42.5 days in the control group (P = .02). (reference) This greater than two week difference in time to return to play after this common injury is clinically and competitively important.
Another recently published in the New England Journal of Medicine (NEJM) found no difference between PRP injections (2 injections spaced about a week apart) and a control group. Interestingly, both groups in this study returned to play at 42 days, very similar to the control group in the AJSM study. (reference)
Why are these results conflicting?
One important difference between the two studies is the type of PRP used to treat the patients. In the study that did show a difference, white blood cell enriched PRP (leukocyte enriched PRP) was used. In the study that did not show a difference, white blood cell poor PRP (leukocyte poor PRP) was used. This is a clear example of why PRP formulation matters.
The data published in elite, peer reviewed journals suggests leukocyte enriched PRP helps return athletes more than two weeks faster than rehabilitation alone after an acute hamstring injury. No difference in return to play can be expected if leukocyte poor PRP is used in this patient population.
As PRP and other cell therapies continue to evolve, it will become increasingly clear that formulations much match indication. Patients, researchers, and clinicians need to realize not all PRP is the same.
July 02, 2014
Fat Stem Cells help Knee Arthritis
Knee Arthritis is a very difficult problem to solve. Millions of patients suffer daily from this progressive disease state. A variety of novel biologic therapies are in development.
Stem cells can come from a variety of sources including your own fat. These cells are known as adipose derived stem cells. A recent study from Korea suggests there is value using this type of cell for knee arthritis. Researchers gave patients escalating dose of the cells and found the high dose resulted in improved pain and function scores. They also found the cartilage defect defect size decreased while the volume of cartilage in the knee increased.
Fat Derived Stem Cells
This data is encouraging and will need to be repeated prior to broad clinical use. (See abstract below)
For patients with this problem, the horizon is bright with many potential options like stem cells from your own fat.
Stem Cells. 2014 May;32(5):1254-66. doi: 10.1002/stem.1634.
Intra-articular injection of mesenchymal stem cells for the treatment of osteoarthritis of the knee: a proof-of-concept clinical trial.
Jo CH1, Lee YG, Shin WH, Kim H, Chai JW, Jeong EC, Kim JE, Shim H, Shin JS, Shin IS, Ra JC, Oh S, Yoon KS.
Author information
Abstract
Mesenchymal stem cells (MSCs) are known to have a potential for articular cartilage regeneration. However, most studies focused on focal cartilage defect through surgical implantation. For the treatment of generalized cartilage loss in osteoarthritis, an alternative delivery strategy would be more appropriate. The purpose of this study was to assess the safety and efficacy of intra-articular injection of autologous adipose tissue derived MSCs (AD-MSCs) for knee osteoarthritis. We enrolled 18 patients with osteoarthritis of the knee and injected AD MSCs into the knee. The phase I study consists of three dose-escalation cohorts; the low-dose (1.0 × 10(7)cells), mid-dose (5.0 × 10(7)), and high-dose (1.0 × 10(8)) group with three patients each. The phase II included nine patients receiving the high-dose. The primary outcomes were the safety and the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) at 6 months. Secondary outcomes included clinical, radiological, arthroscopic, and histological evaluations. There was no treatment-related adverse event. The WOMAC score improved at 6 months after injection in the high-dose group. The size of cartilage defect decreased while the volume of cartilage increased in the medial femoral and tibial condyles of the high-dose group. Arthroscopy showed that the size of cartilage defect decreased in the medial femoral and medial tibial condyles of the high-dose group. Histology demonstrated thick, hyaline-like cartilage regeneration. These results showed that intra-articular injection of 1.0 × 10(8) AD MSCs into the osteoarthritic knee improved function and pain of the knee joint without causing adverse events, and reduced cartilage defects by regeneration of hyaline-like articular cartilage.
Tuesday, June 24, 2014
Platelet Rich Plasma Helps for "High" Ankle Sprains
"High" ankle sprains are significant injuries that typically result in prolonged recovery and time away from sports. This type of injury involves the strong ligaments that connect two of the major bones of the ankle. They are also known as syndesmotic injuries.
A recent randomized, controlled trial found that athletes that were treated with ultrasonic guided injections returned to play faster and has less pain than a control group. Return to play was almost 20 days faster for the PRP group. (40.8 days vs 59.6 days, p = 0.006) (See abstract below)
This data supports the use of PRP for athletes with this type of injury. Further studies will help confirm this value.
Knee Surg Sports Traumatol Arthrosc. 2014 Jun 18. [Epub ahead of print]
Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial.
Laver L1, Carmont MR, McConkey MO, Palmanovich E, Yaacobi E, Mann G, Nyska M, Kots E, Mei-Dan O.
Author information
Abstract
PURPOSE:
Syndesmotic sprains are uncommon injuries that require prolonged recovery. The influence of ultrasound-guided injections of platelet-rich plasma (PRP) into the injured antero-inferior tibio-fibular ligaments (AITFL) in athletes on return to play (RTP) and dynamic stability was studied.
METHODS:
Sixteen elite athletes with AITFL tears were randomized to a treatment group receiving injections of PRP or to a control group. All patients followed an identical rehabilitation protocol and RTP criteria. Patients were prospectively evaluated for clinical ability to return to full activity and residual pain. Dynamic ultrasound examinations were performed at initial examination and at 6 weeks post-injury to demonstrate re-stabilization of the syndesmosis joint and correlation with subjective outcome.
RESULTS:
All patients presented with a tear to the AITFL with dynamic syndesmosis instability in dorsiflexion-external rotation, and larger neutral tibia-fibula distance on ultrasound. Early diagnosis and treatment lead to shorter RTP, with 40.8 (±8.9) and 59.6 (±12.0) days for the PRP and control groups, respectively (p = 0.006). Significantly less residual pain upon return to activity was found in the PRP group; five patients (62.5 %) in the control group returned to play with minor discomfort versus one patient in the treatment group (12.5 %). One patient in the control group had continuous pain and disability and subsequently underwent syndesmosis reconstruction.
CONCLUSIONS:
Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP, re-stabilization of the syndesmosis joint and less long-term residual pain. LEVEL OF EVIDENCE: II.