1,721,011 research outputs found
Intra-articular platelet-rich plasma for the treatment of osteoarthritis
No full textPlatelet-rich plasma (PRP) is an autologous blood derivative
that has been used in different medical fields, ranging from
dermatology to ophthalmology and orthopaedic surgery,
with the aim of stimulating tissue healing through the local
administration of a milieu of platelet-derived growth factors
and other bioactive molecules (1). In the orthopaedic
practice its main application is in sports medicine (2,3) and
in the treatment of degenerative disorders, in particular
osteoarthritis (OA) (4). Due to its intrinsic features, PRP is
believed to play a beneficial role in joint tissue homeostasis,
exerting a positive modulation on all the articular tissues
involved in the OA degenerative process, i.e., cartilage,
menisci, and synovia (5)
Platelet-rich plasma to treat ankle cartilage pathology - from translational potential to clinical evidence: a systematic review
Full text linkPlatelet-rich Plasma (PRP) is a fascinating biological treatment showing promising results for the management of cartilage disorders. However, despite the step forwards in this research area and the increasing use of PRP in clinical practice, its use remains still controversial and especially its application as injective treatment for ankle cartilage pathology have been scarcely investigated.The aim of this paper is to describe the translational evidence for the use of PRP in cartilage treatment and to systematically review all the available evidence regarding the clinical application of PRP for ankle cartilage disorders, in order to understand what is the current state of the art for this specific clinical indication, underlining both limits and potential of this biological strategy.A systematic review of the clinical literature was performed on the use of PRP to treat ankle cartilage disorders and 7 papers were identified. PRP has been used in two different ways: 5 of the available papers focus on its use as an augmentation procedure to various surgical techniques for cartilage regeneration, while only two studies report its conservative application through intra-articular injections. Based on the limited number of clinical studies available on this topic, this systematic review showed the lack of major adverse events related to PRP and overall good results for the treatment of ankle cartilage pathology, thus confirming the translational potential of this biological treatment suggested by several preclinical studies. Further high quality clinical trials in the ankle are still needed to clarify proper indications and best applicative modalities
Biologic agents for anterior cruciate ligament healing: A systematic review
Full text linkAIM To systematically review the currently available literature concerning the application of biologic agents such as platelet-rich plasma (PRP) and stem cells to promote anterior cruciate ligament (ACL) healing. METHODS A systematic review of the literature was performed on the use of biologic agents (i.e., PRP or stem cells) to favor ACL healing during reconstruction or repair. The following inclusion criteria for relevant articles were used: Clinical reports of any level of evidence, written in English language, on the use of PRP or stem cells during ACL reconstruction/repair. Exclusion criteria were articles written in other languages, reviews, or studies analyzing other applications of PRP/stem cells in knee surgery not related to promoting ACL healing. RESULTS The database search identified 394 records that were screened. A total of 23 studies were included in the final analysis: In one paper stem cells were applied for ACL healing, in one paper there was a concomitant application of PRP and stem cells, whereas in the remaining 21 papers PRP was used. Based on the ACL injury pattern, two papers investigated biologic agents in ACL partial tears whereas 21 papers in ACL reconstruction. Looking at the quality of the available literature, 17 out of 21 studies dealing with ACL reconstruction were randomized controlled trials. Both studies on ACL repair were case series. CONCLUSION There is a paucity of clinical trials investigating the role of stem cells in promoting ACL healing both in case of partial and complete tears. The role of PRP is still controversial and the only advantage emerging from the literature is related to a better graft maturation over time, without documenting beneficial effects in terms of clinical outcome, bone-graft integration and prevention of bony tunnel enlargement
A historical perspective on ankle ligaments reconstructive surgery
No full textAnkle sprains are by far the most common injuries treated by sport medicine physicians. Treatment is mainly conservative, but in some cases surgical intervention is required. The aim of the present manuscript is to give an insight into the origins and developments of ankle ligaments reconstructive surgery, underlining the fundamental steps that marked the transition from a mere conservative approach to surgical treatment options. In this historical note, the most illustrious figures who contributed to this particular field of orthopaedic practice are also acknowledged. Level of evidence
Nicolaes Tulp: The Overshadowed Subject in The Anatomy Lesson of Dr. Nicolaes Tulp
No full textIn and out of prison most of his life,
Aris Kindt [12] was known as a petty
thief prone to violence. Such a misery
was Kindt that he was even banned
from his hometown of Leiden in South
Holland. In the winter of 1632, Kindt
was back in a Holland prison for
assault and robbery, having been
apprehended while stealing a man’s cloak [10]. Worse yet for the jailed
thief, the Amsterdam Guild of Surgeons’
annual ‘‘anatomy lesson’’ was
fast approaching, and the Guild needed
a body
The Masters of the Bolognese Orthopaedic School
No full textBologna is one of the most ancient cradles of medical knowledge, as the city hosts one of the oldest medical faculties in the world. Among its best known institutions there is the Rizzoli Orthopaedic Institute, founded in the late nineteenth century, whose history is strictly connected with the evolution and development of the Italian orthopaedic practice of the last 120 years. The present manuscript acknowledges the main contributions by Francesco Rizzoli, Alessandro Codivilla and Vittorio Putti, who prompted the foundation and the international recognition of the Rizzoli Institute and the related Bolognese Orthopaedic School
Platelet-rich plasma in tendon-related disorders: results and indications
No full textPurpose: Platelet-rich plasma (PRP) is currently the most exploited strategy in the clinical practice to provide a regenerative stimulus for tendon healing. The aim of the present study was to systematically review the available evidence on the treatment of the main tendon disorders where PRP is currently applied. Methods: A systematic review of the literature was performed on the use of PRP as a treatment for tendinopathies focusing on the following sites: Achilles tendon, patellar tendon, rotator cuff tendons, and lateral elbow tendons. The following inclusion criteria for relevant articles were used: clinical trials written in English language up to 21 June 2016 on the use of PRP in the conservative or surgical treatment of the aforementioned tendinopathies. Results: The research identified the following clinical trials dealing with the application of PRP in the selected tendons: 19 papers on patellar tendon (6 being RCTs: 4 dealing with PRP conservative application and 2 surgical), 24 papers on Achilles tendon (4 RCTs: 3 conservative and 1 surgical), 29 on lateral elbow tendons (17 RCTs, all conservative), and 32 on rotator cuff (22 RCTs: 18 surgical and 3 conservative). Conclusion: Patellar tendons seem to benefit from PRP injections, whereas in the Achilles tendon, PRP application is not indicated neither as a conservative approach nor as a surgical augmentation. Lateral elbow tendinopathy showed an improvement in most of the high-level studies, but the lack of proven superiority with respect to the more simple whole-blood injections still questions its use in the clinical practice. With regard to rotator cuff pathology, the vast majority of surgical RCTs documented a lack of beneficial effects, whereas there is still inconclusive evidence concerning its conservative application in rotator cuff disorders. Level of evidence: Systematic review of level I–IV trials, Level IV
Prp with or without leukocytes: any difference on chondrocytes and synoviocytes culture?
No full textObjectives: Platelet Rich Plasma (PRP) is a biological compound rich
of growth factors able to support healing processes, and it represents a
fascinating tool for clinicians. However results on its potentiality as
intra-articular treatment for cartilage degenerative lesions in osteoarthritis
(OA) are still controversial, due to the lack of well designed
studies and the differences in the preparation procedures. The aim of
this study was to analyze the modifications induced by two different
PRP preparations on chondrocytes and sinoviocytes in culture, by
documenting changes in proliferations, gene expression, and extracellular
matrix components deposition.
Methods: Blood collected from 10 volunteers was used to obtain two
PRP preparations derived respectively from a ‘‘one-spinning procedure’’,
to obtain a pure platelet concentrate without leukocytes but
with a limited number of platelets (P-PRP), and by a ‘‘two-spinning
approach’’, producing a product characterized by a higher platelet
concentration and the presence of leukocytes (L-PRP).
Results: Our data showed that L-PRP contains higher levels of growth
factors and cytokines compared to P-PRP. Both PRPs stimulate
chondrocytes proliferation during all the culture period evaluated; a
significant enhancement in cell growth was induced by P-PRP respect
to L-PRP only at day 7. Moreover, P-PRP stimulates chondrocyte
anabolism as demonstrated by the expression of collagen type II and aggrecan, while L-PRP promotes catabolic pathways in which some
different cytokines are involved. Interesting, L-PRP induces a higher
expression of hyaluronic acid synthase-2 and hyaluronan compared to
P-PRP. On sinoviocytes, L-PRP is able to sustain the up-regulation of
proinflammatory factors, such as IL-1beta, IL-8 and FGF-2, together
with a down modulation of HGF and TIMP-4 expression, two factors
that have been recognized as anti-catabolic mediators in cartilage,
whereas P-PRP was not able to exert a differential pattern of biological
effect compared to PPP.
Conclusions: Our study highlights that the two PRPs induce distinct
effects on cultured human chondrocytes and sinoviocytes. This is due
to the different content in PRP of platelets, leukocytes, growth factors
and molecules that act synergically to regulate several biological
processes which could influence the regeneration of a functional
tissue
Intra-Articular Injection of Botulinum Toxin for the Treatment of Knee Osteoarthritis: A Systematic Review of RandomizedControlled Trials
Full text linkThe purpose of the present paper was to review the available evidence on intra-articular
botulinum toxin (BTX) injection in the treatment of knee osteoarthritis and to compare it to other conservative treatment options. A systematic review of the literature was performed on the PubMed, Scopus, Cochrane Library, Web of Science, Pedro and Research Gate databases with the following inclusion criteria: (1) randomized controlled trials (RCTs), (2) written in the English language, and (3) published on indexed journals in the last 20 years (2001–2021) dealing with the use of BTX intraarticular injection for the treatment of knee OA. The risk of bias was assessed using the Cochrane Risk of Bias tool for RCTs. Nine studies involving 811 patients in total were included. Patients in the control groups received different treatments: conventional physiotherapy, hyaluronic acid injection or prolotherapy or a combination thereof in 5 studies, steroid infiltrative therapy (triamcinolone) in 1 study, placebo in 2, and local anesthetic treatment in 1 study. Looking at the quality of the available literature, two of the included studies reached “Good quality” standard, three were ranked as “Fair”, and the rest were considered “Poor”. No major complications or serious adverse events were reported following intra-articular BTX, which provided encouraging pain relief, improved motor function, and quality of life. Based on the available data, no clear indication emerged from the comparison of BTX with other established treatments for knee OA. The analysis of the available RCTs on BTX intra-articular injection for the treatment of knee OA revealed modest methodological quality. However, based on the data retrieved, botulinum toxin has been proven to provide good short-term outcomes, especially in patients with pain sensitization, by modulating neurotransmitter release, peripheral nociceptive transduction, and acting on the control of chronic pain from central sensitization
- …
