Platelet Rich Plasma Therapy, once reserved for elite athletes, continues to gain popularity among the general public. Research
is also overwhelmingly positive in the treatment of numerous musculoskeletal complaints. The following article shows the potential
for PRP to improve knee osteoarthritis also known as degenerative joint disease. This is especially exciting because medical
treatment for osteoarthritis is mostly inadequate. If you or someone you know is suffering from knee pain, or other joint pains,
PRP may be an effective treatment option for you. If you have any questions, you can contact me either via email or call the clinic.
Platelet-rich plasma (prp) treatment shows potential for knee osteoarthritis
Date: February 12, 2013
Source: Hospital for Special Surgery
Summary: A new study has shown that platelet-rich plasma (PRP) holds great promise for treating patients with knee osteoarthritis. The treatment improved pain and function, and in up to 73% of patients, appeared to delay the progression of osteoarthritis.
A study by researchers from Hospital for Special Surgery has shown that platelet-rich plasma (PRP) holds great promise for treating patients with knee osteoarthritis. The treatment improved pain and function, and in up to 73% of patients, appeared to delay the progression of osteoarthritis, which is a progressive disease. The study appears online, ahead of print, in the Clinical Journal of Sports Medicine.
“This is a very positive study,” said Brian Halpern, M.D., chief of the Primary Care Sports Medicine Service at Hospital for Special Surgery, New York City, and lead author of the study.
Several treatments for osteoarthritis exist, including exercise, weight control, bracing, nonsteroidal anti-inflammatories, Tylenol, cortisone shots and viscosupplementation, a procedure that involves injecting a gel-like substance into the knee to supplement the natural lubricant in the joint. A new treatment that is being studied by a small number of doctors is PRP injections. PRP, which is produced from a patient’s own blood, delivers a high concentration of growth factors to arthritic cartilage that can potentially enhance healing.
“You take a person’s blood, you spin it down, you concentrate the platelets, and you inject a person’s knee with their own platelets in a concentrated form,” said Dr. Halpern. “This then activates growth factors and stem cells to help repair the tissue, if possible, calm osteoarthritic symptoms and decrease inflammation.”
In the new study, researchers at Hospital for Special Surgery enrolled patients with early osteoarthritis, gave them each an injection of PRP (6-mL), and then monitored them for one year. Fifteen patients underwent clinical assessments at baseline, one week, and one, three, six, and 12 months. At these time points, clinicians used validated tools to assess overall knee pain, stiffness and function, as well as a patient’s ability to perform various activities of daily living. At baseline and then one year after the PRP injection, physicians also evaluated the knee cartilage with magnetic resonance imaging (MRI), something that has not previously been done by researchers in other PRP studies. The radiologists reading the MRIs did not know whether the examination was performed before or after the PRP treatment.
“The problem with a lot of the PRP studies is that most people have just used subjective outcome instruments, such as pain and function scores,” said Hollis Potter, M.D., chief of the Division of Magnetic Resonance Imaging at Hospital for Special Surgery, another author of the study. “But even when patients are blinded, they know there has been some treatment, so there is often some bias interjected into those types of studies. When you add MRI assessment, it shows you the status of the disease at that time, regardless of whether the patient is symptomatic or asymptomatic or they have good or poor function in the knee. You find out what the cartilage actually looks like. We can noninvasively assess the matrix or the building blocks of cartilage.”
While previous studies have shown that patients with osteoarthritis can lose roughly five percent of knee cartilage per year, the HSS investigators found that a large majority of patients in their study had no further cartilage loss. “The knee can be divided into three compartments, the medial compartment, the lateral compartment and the patellofemoral compartment,” said Dr. Halpern. “If we look at these compartments individually, which we did, in at least 73% of these cases, there was no progression of arthritis per compartment at one year. That is very significant, because longitudinal studies suggest a four to six percent progression of arthritis at one year.”
Treatment with PRP was also useful in improving pain, stiffness and function. The investigators found that pain, measured by a standard test called the Western Ontario and McMaster Universities Arthritis Index, significantly improved with a reduction of 41.7% at six months and 55.9% at one year. On a pain scale commonly used by clinicians called the Visual Analog Scale, pain was reduced by 56.2% at six months and 58.9% at one year. Functional scores improved by 24.3% at one year. Activity of Daily Living Scores also showed a significant increase at both six months (46.8%) and one year (55.7%).
“We are entering into an era of biologic treatment, which is incredibly ideal, where you can use your own cells to try to help repair your other cells, rather than using a substance that is artificial,” Dr. Halpern said. “The downside is next to zero and the upside is huge.” Dr. Halpern pointed out, however, that the study is a small case series and PRP needs to be pitted against a traditionally treated group in a randomized, controlled trial.
Osteoarthritis, which causes pain and joint stiffness, impacts over 27 million Americans and is a leading cause of disability. According to statistics from the Centers for Disease Control and Prevention, overall osteoarthritis affects 13.9% of adults aged 25 and older and 33.6% of those older than 65. The disease is characterized by degeneration of cartilage and its underlying bone within a joint as well as bony overgrowth. Disease onset is gradual and usually begins after the age of 40.
Other HSS investigators involved in the study include Salma Chaudhury, M.D., Ph.D, Scott Rodeo, M.D., Catherine Hayter, MBBS, Eric Bogner, M.D., and Joseph Nguyen, MPH.
The above story is based on materials provided by Hospital for Special Surgery.Note: Materials may be edited for content and length.
- Brian Halpern, Salma Chaudhury, Scott A. Rodeo, Catherine Hayter, Eric Bogner, Hollis G. Potter, Joseph Nguyen. Clinical and MRI Outcomes After Platelet-Rich Plasma Treatment for Knee Osteoarthritis. Clinical Journal of Sport Medicine, 2012; 1 DOI: 10.1097/JSM.0b013e31827c3846
A colleague and someone that I learned directly from, Jeff Patterson DO, co-authored a recent blinded trial of dextrose prolotherapy vs. placebo injection or exercise therapy. The results suggested that prolotherapy is an effective solution for knee osteoarthritis with reductions in pain and stiffness and an increase in range of motion and function. This is not new, but more confirmatory results of the effectiveness of prolotherapy for numerous types of joint pain and musculoskeletal complaints.
June 04, 2013
Dextrose Prolotherapy Can Improve Knee Osteoarthritis
(HealthDay News) – For adults with knee osteoarthritis, dextrose prolotherapy is associated with greater improvements in pain, function, and stiffness compared with saline injections or at-home exercise, according to a study published in the May/June issue of the Annals of Family Medicine.
David Rabago, MD, of the University of Wisconsin School of Medicine and Public Health in Madison, and colleagues conducted a three-arm blinded, randomized controlled trial involving 90 adults with ≥3 months of painful knee osteoarthritis. Participants were randomized to receive blinded injection (dextrose prolotherapy or saline) or at-home exercise. Injections were provided at weeks one, five, and nine, with additional treatments at weeks 13 and 17, as needed. An exercise manual and in-person instruction were provided to exercise participants.
The researchers found that all groups reported an improvement in composite Western Ontario McMaster University Osteoarthritis Index (WOMAC) scores from baseline to 52 weeks. The improvement in WOMAC scores at 52 weeks was significantly more for the dextrose prolotherapy group compared with the saline or exercise groups, after adjustment for age, sex, and body mass index. In the prolotherapy group, the individual knee pain scores also improved more. High satisfaction was noted with prolotherapy and there were no adverse events reported.
“Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises,” the authors write.
The Abstract From the Recent Study:
Dextrose Prolotherapy for Knee Osteoarthritis: A Randomized Controlled Trial
- David Rabago, MD1⇑, Jeffrey J. Patterson, DO1, Marlon Mundt, PhD1,Richard Kijowski, MD2, Jessica Grettie, BS1, Neil A. Segal, MD, MS3 andAleksandra Zgierska, MD, PhD1
Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Departments of Orthopaedics & Rehabilitation, Epidemiology, and Radiology, The University of Iowa, Iowa City, Iowa
David Rabago, MD, Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI 53715, email@example.com
Knee osteoarthritis is a common, debilitating chronic disease. Prolotherapy is an injection therapy for chronic musculoskeletal pain. We conducted a 3-arm, blinded (injector, assessor, injection group participants), randomized controlled trial to assess the efficacy of prolotherapy for knee osteoarthritis.
Ninety adults with at least 3 months of painful knee osteoarthritis were randomized to blinded injection (dextrose prolotherapy or saline) or at-home exercise. Extra- and intra-articular injections were done at 1, 5, and 9 weeks with as-needed additional treatments at weeks 13 and 17. Exercise participants received an exercise manual and in-person instruction. Outcome measures included a composite score on the Western Ontario McMaster University Osteoarthritis Index (WOMAC; 100 points); knee pain scale (KPS; individual knee), post-procedure opioid medication use, and participant satisfaction. Intention-to-treat analysis using analysis of variance was used.
No baseline differences existed between groups. All groups reported improved composite WOMAC scores compared with baseline status (P <.01) at 52 weeks. Adjusted for sex, age, and body mass index, WOMAC scores for patients receiving dextrose prolotherapy improved more (P <.05) at 52 weeks than did scores for patients receiving saline and exercise (score change: 15.3 ± 3.5 vs 7.6 ± 3.4, and 8.2 ± 3.3 points, respectively) and exceeded the WOMAC-based minimal clinically important difference. Individual knee pain scores also improved more in the prolotherapy group (P = .05). Use of prescribed postprocedure opioid medication resulted in rapid diminution of injection-related pain. Satisfaction with prolotherapy was high. There were no adverse events.
Prolotherapy resulted in clinically meaningful sustained improvement of pain, function, and stiffness scores for knee osteoarthritis compared with blinded saline injections and at-home exercises.
For full text of this research study: http://www.annfammed.org/content/11/3/229.full
Dr Glen Jarosz is a skilled practitioner of prolotherapy as well as numerous other regenerative injection therapies. Please contact him for a free consultation to see if you may benefit from prolotherapy.
It is interesting to note that the classical tender points of fibromyalgia are over tendon and ligament insertions. These insertion points have the lowest pain threshold of any somatic structure, meaning, even a small stimulus can be interpreted as a large amount of pain. Weak or lax ligaments are potential nociceptors (nerve stimulus receptors) in fibromyalgia, and that this is potentially correctable with prolotherapy.
Treatment of Consecutive Severe Fibromyalgia Patients with Prolotherapy,
- Dean Reeves, MD
Abstract: The potential of tendon and ligament triggers as primary nociceptors in fibromyalgia led to treatment of primary fibromyalgia patients with tendon and ligament strengthening injections. The injection of ligaments and tendons with proliferant (Prolotherapy) offers the advantage of creating increased strength of the connective tissue in the region of injection as well as affecting the pain cycle. Reduction in pain levels and increased functional abilities were seen in excess of 75% of patients with severe fibromyalgia in this study.
Journal of Orthopaedic Medicine Vol 16 1994 No 3
For full research article go to:
More and more research is being published about the benefits of prolotherapy for numerous musculoskeletal complaints, this particular one on knee osetoarthritis. Prolotherapy is a form of regenerative injection technique that is very effective at treating injuries to tendons and ligaments. It has also been shown to be beneficial for arthritis and discopathy. If you have pain or instability at or around a joint that impairs your daily activities, contact Dr Jarosz for more information.
Effect of Regenerative Injection Therapy on Function and Pain in Patients with Knee Osteoarthritis: A Randomized Crossover Study.
Dumais R, Benoit C, Dumais A, Babin L, Bordage R, de Arcos C, Allard J, Bélanger M. Pain Med. 2012 Jul 3. doi: 10.1111/j.1526-4637.2012.01422.x. [Epub ahead of print]
Dr. Georges-L.-Dumont Regional Hospital, Vitalité Health Network, Moncton, New Brunswick Centre de formation médicale du Nouveau-Brunswick, Moncton, New Brunswick Dieppe Family Medicine Unit, Dieppe, New Brunswick Department of Family Medicine, Université de Sherbrooke, Sherbrooke, Quebec Department of Mathematics and Statistics, Université de Moncton, Moncton, New Brunswick Research Centre, Vitalité Health Network, Moncton, New Brunswick, Canada.
Objective. We assessed the effectiveness of regenerative injection therapy (RIT) to relieve pain and restore function in patients with knee osteoarthritis. Design. Crossover study where participants were randomly assigned to receive exercise therapy for 32 weeks in combination with RIT on weeks 0, 4, 8, and 12 or RIT on weeks 20, 24, 28, and 32. Patients. Thirty-six patients with chronic knee osteoarthritis. Interventions. RIT, which is made up of injections of 1 cc of 15% dextrose 0.6% lidocaine in the collateral ligaments and a 5 cc injection of 20% dextrose 0.5% lidocaine inside the knee joint. Outcome Measures. The primary outcome was the Western Ontario and McMaster Universities Osteoarthritis Index of severity of osteoarthrosis symptoms (WOMAC) score (range: 0-96). Results. Following 16 weeks of follow-up, the participants assigned to RIT presented a significant reduction of their osteoarthritis symptoms (mean ± standard deviation: -21.8 ± 12.5, P < 0.001). WOMAC scores in this group did not change further during the last 16 weeks of follow-up, when the participants received exercise therapy only (-1.2 ± 10.7, P = 0.65). WOMAC scores in the first 16 weeks did not change significantly among the participants receiving exercise therapy only during this period (-6.1 ± 13.9, P = 0.11). There was a significant decrease in this groups’ WOMAC scores during the last 16 weeks when the participants received RIT (-9.3 ± 11.4, P = 0.006). After 36 weeks, WOMAC scores improved in both groups by 47.3% and 36.2%. The improvement attributable to RIT alone corresponds to a 11.9-point (or 29.5%) decrease in WOMAC scores. Conclusions. The use of RIT is associated with a marked reduction in symptoms, which was sustained for over 24 weeks.