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Month: February 2016

We no longer offer PRP and Stem Cell procedures until further scientific evidence of its efficacy. We do PROLO Therapy for specific orthopedic conditions.

Prolotherapy for Rotator Cuff Disease

In follow-up to a previous blog from October 2015 regarding prolotherapy in the treatment of rotator cuff disorders, another study was recently published showing positive results.

Lee et al (Arch Phys Med Rehab 2015) performed a retrospective case-control study evaluating prolotherapy in the treatment of rotator cuff disease. In this study, 63 patients received prolotherapy, consisting of 16.5% dextrose solution and 63 patients received conservative treatment. The outcome measures of the study included the visual analog scale (VAS), average shoulder pain score for the past week, Shoulder Pain and Disability Index Score, active range of shoulder motion, isometric shoulder strength, and medication (analgesic) use per day. At one year of follow-up, patients in the prolotherapy group received an average of 4.8 ± 1.3 injections and had significant improvements in VAS, SPADI scores, isometric strength, and active range of motion when compared with the control group.

As the authors pointed out, prolotherapy appeared to be effective in the treatment of chronic rotator cuff disease (duration of at least 3 months), however, as this study was non-randomized and retrospective in nature, the results must be interpreted with caution.

This is the second recent study to conclude that dextrose prolotherapy is efficacious in the treatment of rotator cuff disease. Bertrand et al (Arch Phys Med Rehab 2016) showed that injections of hypertonic dextrose resulted in superior long term pain improvement and patient satisfaction for those with painful rotator cuff tendinopathy. As with many prolotherapy investigations, it is often difficult to compare studies as the specific diagnosis from one study to another often differs as does the treatment protocol and outcome measures. Nonetheless, prolotherapy does appear to be beneficial for a number of musculoskeletal condition with no reported adverse events.

The use of PRP in orthopaedics: AAOS Now review article

· Platelet Rich Plasma (PRP) · No Comments

Platelet Rich Plasma (PRP) is the headline story of this month’s edition of The American Academy of Orthopaedic Surgeons (AAOS) publication AAOS Now. The article titled, “PRP: Does it Do Anything?” was written by senior author, Scott Duncan, M.D., MPH, MBA, who is the current chairman of the Department of Orthopaedic Surgery at Boston University Medical Center along with three orthopaedic surgical residents. As presented in the article, the optimal platelet concentration for PRP is believed to be 3 to 5 times that of whole blood. This does appear to be consistent with other published review articles. Concentrations higher than this may actually pose a detriment to healing. Previously discussed by PRPPROLOTHERAPYTAMPA and duplicated in this article, the literature continues to slowly expand with high quality investigations, but the biggest problem remains in trying to compare studies. Significant differences in PRP preparation, injection technique and treatment protocols for a specific musculoskeletal condition presents challenges when trying to assess the evidence. In some cases, published studies have had a sound methodological plan, but have had small samples sizes. PRP has been used to treat a wide array of disorders, but again we have not yet truly defined what it is clinically appropriate for.

This article by Parisien et al does discuss the use of PRP for conditions including osteoarthritis, fracture care, lumbar fusion, and ACL reconstruction. The potential benefits of PRP along with selected studies including randomized clinical trials (level I and II evidence) in some cases, were presented but the general conclusion is that limited evidence currently exists to support use for these specific conditions. It was noted that there is some benefit shown for the application of PRP into the patellar and tibial plug donor sites in ACL reconstruction. Two quoted studies were used in this assessment which have shown improved postoperative VAS scores and decreased patella tendon gap on MRI 6 months post-operatively.

In the opinion of PRPPROLOTHERAPYTAMPA, this review article published in AAOS Now does paint a realistic picture of the current state of PRP use in orthopaedics. PRP is widely used to treat a multitude of soft tissue and bony disorders and may be an effective alternative treatment but we still do not have firm evidence to support this. Standardization of PRP preparations, administration, injection protocols and outcome measures are imperative if we wish to be able to define effectiveness and eventually produce evidenced based treatment algorithms. The overall conclusions published by the authors of this paper are very similar to that of the consensus drawn from the 2011 AAOS Now PRP forum.

References:

  • Parisien RL, Trofa DP, Dashe J, Duncan SFM. PRP: Does it do anything? AAOS Now. February 2016.