PRP reduces donor site knee pain in bone-patellar tendon-bone ACL reconstruction40 patients who required bone-patellar tendon-bone ACL reconstruction were randomized to have platelet-rich plasma (PRP) gel applied or no PRP additive to determine its effect on pain and donor-site morbidity following surgery. Visual Analog Scales (VAS), Victorian Institute Sport Assessment scores and MRI analysis were recorded 12 months postoperatively. The results suggested that patients who received application of PRP gel experienced less pain through the VISA scale compared to those who did not, but VAS scores and donor-site morbidity did not differ between groups.
PRP reduces donor site knee pain in bone-patellar tendon-bone ACL reconstruction
ISAKOS: Better quality & quantity of repair tissue with BST-CarGel® in cartilage lesions80 patients with focal cartilage lesions were randomized to receive either BST-CarGel® + microfracture treatment or microfracture-only treatment. Results indicated an increase in the quality and quantity of the cartilage repair tissue (assessed using MRI and osteochondral biopsies) at 12 months post-treatment. There was no difference in clinical outcomes such as pain, stiffness and function (assessed using the WOMAC score) between groups.
ISAKOS: Better quality & quantity of repair tissue with BST-CarGel® in cartilage lesions
ISAKOS: No differences between PT and HS grafts in ACL reconstructionThe trial conducted a long term follow up of a randomized trial investigate the differences between graft types in anterior cruciate ligament (ACL) reconstruction. 65 patients were randomized to either using patellar tendon (PT) or hamstring tendon (HS) graft. 15 year results demonstrated no differences in patient related and functional outcomes of both procedures; however, osteoarthritis risk depended on the age of the patient.
ISAKOS: No differences between PT and HS grafts in ACL reconstruction
ISAKOS: No advantageous effect of postoperative knee bracing following ACL reconstruction64 patients underwent anteroir cruciate ligament (ACL) reconstruction and were randomized to receive a postoperative stabilizing knee brace or not. Patients who were given the brace were instructed to wear it for 6 weeks. Results at 4-year follow-up indicated that bracing had no effect on functional outcome and x-ray findings in comparison to non-bracing. Furthermore, pain and the single-hop leg test were observed to be significantly better in patient not receiving a knee brace, calling into question the efficacy of bracing following ACL reconstruction.
ISAKOS: No advantageous effect of postoperative knee bracing following ACL reconstruction
ISAKOS: TKA: Increased time to restore quadriceps strength if incision length is >4cm60 patients who underwent unilateral minimally invasive TKA were randomized to receive treatment using an incision length in the quadriceps muscle of either < 2cm, between 2 and 4cm, or > 4cm to determine the effect of incision size on rate of healing and quadriceps strength. Results indicated an increase in time taken to restore preoperative quadriceps strength in patients who had an incision length of > 4cm, compared to the other two groups. However, there was no difference found in operative time, blood loss, or hospital stay between the three groups.
ISAKOS: TKA: Increased time to restore quadriceps strength if incision length is >4cm
ISAKOS: Bone tunnel placement no more accurate in computer-assisted ACL reconstruction100 patients were randomized to determine if bone tunnel placement was more accurate in computer-assisted anterior cruciate ligament (ACL) reconstruction in comparison to conventional surgery. 3-dimensional CT scans following surgery indicated that femoral and tibial tunnel placement was no more accurate or precise in patients who had undergone computer-assisted surgery than those who had undergone conventional ACL reconstruction.
ISAKOS: Bone tunnel placement no more accurate in computer-assisted ACL reconstruction
ISAKOS: Free or Restricted Rehabilitation After Meniscus Repair60 patients who had undergone arthroscopic repair of vertical meniscus lesions were randomized to either a free or a strict rehabilitation program after to compare the functional, healing, and patient related outcomes of the two protocols. Follow-up at one year follow demonstrated a slightly better healing rate for the free rehabilitation group, with no differences between the groups in Knee Osteoarthritis Outcome Score (KOOS), Tegner score, pain and patient satisfaction.
ISAKOS: Free or Restricted Rehabilitation After Meniscus Repair
ISAKOS: Complications after ACL reconstruction with PT, HT, DB autografts are common330 patients were randomized to undergo anterior cruciate ligament (ACL) reconstruction with either a patellar tendon (PT), a quadruple-stranded hamstring (HT), or a double-bundle hamstring (DB) autograft, to compare incidence of post-operative adverse effects between surgical methods. Following assessments over a 2 year period, results indicated that 13% of patients repeat surgery. Repeat surgery was required in 8.2%, 17.3% and 14.5% of the patients with PT, HT and DB procedures respectively.Patients with HT and DB autografts experienced more hamstring injuries compared to the PT group. However, the PT group had a higher incidence of kneeling pain, compared to the other two groups.
ISAKOS: Complications after ACL reconstruction with PT, HT, DB autografts are common
ISAKOS: Injury rate reduced in basketball players who warm-up with the FIFA 11+ programA total of 121 male youth basketball players were cluster randomized, by team, to determine the effect of the FIFA 11+ warm-up program on the prevention of injuries. 11 teams were allocated to the institution of the warm-up program or not. The duration of the study was the 9-month basketball season, of which the primary outcome was the incidence of sustaining an injury related to sport. Results at the end of the study indicated a significantly lower rate of injury in participants who warmed-up according to the FIFA 11+ program than those who did not.
ISAKOS: Injury rate reduced in basketball players who warm-up with the FIFA 11+ program
ISAKOS: Open in situ & endoscopic decompression for treatment of cubital tunnel syndrome30 patients with cubital tunnel syndrome were randomized to undergo decompression of the ulnar nerve using either the open in situ or endoscopic method, in order to compare which technique was more effective. Following assessments over a 12 month period, results indicated that endoscopic decompression of the ulnar nerve provided slightly better outcomes than open in situ decompression, but this difference was not significant.
ISAKOS: Open in situ & endoscopic decompression for treatment of cubital tunnel syndrome
ISAKOS: Similar outcome in double-bundle HS and rectangular tunnel BPTB ACL reconstruction189 anterior cruciate ligament (ACL) reconstructions were performed with either a double-bundle hamstring approach or rectangular tunnel technique with bone-patellar tendon-bone graft. The purpose was to determine if there was a difference in outcome between the two reconstruction techniques. Patients underwent clinical evaluation for 2 years postoperatively. Results at final follow-up indicated that knee laxity, clinical outcome, and muscle strength evaluations were similar between groups, although those who had undergone the rectangular tunnel ACL reconstruction with the patellar tendon did experience lower quadriceps strength within the first 9 postoperative months.
ISAKOS: Similar outcome in double-bundle HS and rectangular tunnel BPTB ACL reconstruction
ISAKOS: Non-significant decrease in pain and no difference in QOL in PRP group at 6 weeks50 patients suffering from rotator cuff tears were randomized to either receive 2 PRP injections or 2 saline injections, during the operation and 4 weeks post-operation. At the interim analysis (which included 11 patients in each group), results indicate a non-significant decrease in VAS pain scores from baseline to 6 weeks in the PRP group. In addition, quality of life (assessed using DASH scores) remained relatively unchanged from baseline to 6 weeks in the PRP group.
ISAKOS: Non-significant decrease in pain and no difference in QOL in PRP group at 6 weeks
ISAKOS: Frozen shoulder manipulation under anaesthesia vs arthroscopic release78 patients with idiopathic frozen shoulder were randomized to undergo treatment via manipulation under anaesthesia (MUA) in conjunction with a steroid injection technique or an arthroscopic release method, in order to determine which approach provided better functional results. After evaluations over an average follow-up period of 14.6 months, results indicated that Oxford Shoulder and DASH scores were significantly better in patients who underwent MUA and steroid injections.
ISAKOS: Frozen shoulder manipulation under anaesthesia vs arthroscopic release
ISAKOS: Lower laxity and re-rupture rate with patellar tendon compared to hamstring330 patients with anterior cruciate ligament deficiency were randomized to undergo ACL reconstruction with one of the following three techniques: anatomic patellar tendon, anatomic quadruple-stranded hamstring tendon, or anatomic double-bundle using hamstring tendons. Patients were followed up for a minimum of 2 years, primarily observing disease-specific quality of life. At final follow-up, there was no difference between groups for disease-specific quality of life, although reconstruction with patellar tendons was associated with less knee laxity and a lower number of traumatic re-ruptures. There were no significant differences in any other outcome measured.
ISAKOS: Lower laxity and re-rupture rate with patellar tendon compared to hamstring
Aerobic walking programme for CLBP patients effective in improving functional outcome52 patients with chronic low back pain were randomized to compare the effect of aerobic walking training versus active training in improving functional abilities. Patients performed either moderate-to-intense treadmill walking or specific low back exercises twice a week for 6 weeks and were re-assessed at the end of this period. Results indicated that aerobic walking led to comparable results in the six-minute walk test, trunk flexor endurance, and health functional status as specific strengthening exercises.
Aerobic walking programme for CLBP patients effective in improving functional outcome
48-hour delay in early mobilization beneficial in radial head fractures180 consecutive patients (mean age 36.8) with simple radial head fractures were randomly allocated into 3 different protocols to compare effects of early and delayed mobilization on non-operative healing. The first group underwent immediate mobilization of the elbow joint, the second had a sling for 2 days and then active mobilization, and the third protocol was immobilized in a cast for 7 days. After 2 years of assessment, early mobilization had better clinical outcomes, and 48- hour delay in mobilization had the best range of motion, strength, and functional outcome, especially in displaced fractures. A fragment displacement of more than 4 mm and an angulation of more than 30 degrees impaired outcome.
48-hour delay in early mobilization beneficial in radial head fractures
Extramedullary femoral alignment system provides reliable limb alignment for TKA91 patients (106 knees) undergoing total knee arthroplasty who had varus deformities (TKA) were randomized to undergo the surgical procedure using either the intramedullary alignment (IM) or extramedullary femoral alignment (EM) systems, in order to compare the femoral alignment resulting from each procedure. Following evaluations, the results indicated that the EM technique provided reliable limb alignment and was produced similar positioning when compared to the IM procedure.
Extramedullary femoral alignment system provides reliable limb alignment for TKA
Continuous infusion of bupivacaine following TKA does not improve morphine consumption67 patients were randomized in this pilot study to evaluate the efficacy of a 48h continuous local infiltration of bupivacaine on reducing morphine consumption following total knee arthroplasty (TKA). Patients received either local infiltration of intra-articular bupivacaine (0.5% at 2 cc/h) or placebo (0.5% saline at 2 cc/h) and were assessed over the first 48 hours and at 1 year. Results revealed that there were no significant differences between both groups regarding morphine consumption, pain scores, or any of the other clinical outcome measures.
Continuous infusion of bupivacaine following TKA does not improve morphine consumption
Comparing knee kinematics of cruciate-substituting and cruciate-retaining implants for TKA60 patients were randomized to examine whether cruciate-substituting (PS) and cruciate-retaining (CS) total knee arthroplasty (TKA) led to different knee kinematics. Patients received either one of the two procedures and were assessed preoperatively and at 6 months using computer navigation. The results indicated that there were no significant differences in navigation-based knee kinematics between CR and PS implants.
Comparing knee kinematics of cruciate-substituting and cruciate-retaining implants for TKA
Epidural Injection of Ropivacaine Effective in Posterior Lumbar Interbody Spinal Arthrodes60 patients undergoing planned one-level posterior lumbar interbody arthrodesis were randomized to study the analgesic effectiveness of a single epidural injection of ropivacaine. Patients received either a 10-mL epidural injection of 0.1% ropivacaine 20 minutes before the skin incision or a control epidural injection of 10 mL of 0.9% saline solution. Outcomes were assessed of the first 48 hours postoperatively and at discharge. Ropivacaine injection provided better early postoperative analgesia and decreased fentanyl consumption within 12 hours, without related complications such as transient motor weakness.
Epidural Injection of Ropivacaine Effective in Posterior Lumbar Interbody Spinal Arthrodes
BPTB and DLSG grafts for ACL reconstruction: No difference in long-term functional outcome114 patients were randomized to compare the long-term functional outcomes of two different techniques for anterior cruciate ligament (ACL) reconstruction. Patients with ACL ruptures received either bone-patellar tendon-bone (BPTB) grafts fixed with metal interference screws or double-looped semitendinosus and gracilis (DLSG) graft fixed with the Bone Mulch Screw and WasherLoc. The assessment at 7 years revealed that both procedures led to similar, but satisfactory results regarding the subjective and objective measurements for knee function.
BPTB and DLSG grafts for ACL reconstruction: No difference in long-term functional outcome
Direct referral for DXA scan lead to improved diagnosis and treatment of osteoporosisThe management of osteoporosis following a fragility fracture has traditionally been deficient. This study compared the assessment and treatment rates of two different models of screening for osteoporosis following fragility fracture, 66 patients were randomized to either the intervention group, assessment for osteoporosis that was initiated in the fracture clinic, or to the control group, where the assessment was initiated by the participant's general practitioner. The follow-up at 3 months revealed that the assessment rate was significantly better in patients who were referred by the fracture clinic; however, the treatment rates were similar between the two groups.
Direct referral for DXA scan lead to improved diagnosis and treatment of osteoporosis
Efficacy of platelet-rich plasma in the treatment of lateral epicondylitisSix ACE Reports of randomized controlled trials were identified from the OrthoEvidence database that evaluated the use of PRP and blood product injections compared to corticosteroids injections for the treatment of lateral epicondylitis to determine the efficacy of PRP in this patient population. Evaluated outcomes included visual analog scale (VAS) for pain, Disabilities of the Arm, Shoulder, and Hand (DASH) scores, the Patient-Rated Tennis Elbow Evaluation (PRTEE) questionnaire, Upper Extremity Functional Scale (UEFS) for upper extremity disorders, the Liverpool Elbow function score, grip strength, and tendon thickness. Results from statistical pooling (VAS and DASH) indicated that a favourable outcome for PRP treatment was apparent after 12 months; however, corticosteroids were favoured over the short term follow-up (first month). Outcomes that were not poolable, also displayed a similar pattern towards the long term effectiveness of PRP and blood product injections in the treatment of lateral epicondylitis.
Efficacy of platelet-rich plasma in the treatment of lateral epicondylitis
Mini-midvastus & mini-medial parapatellar approach in TKA show similar short-term results89 patients were randomized to receive total knee arthroplasty (TKA) using either a mini-midvastus or mini-medial parapatellar approach to compare their short-term clinical and radiological outcomes. The assessment at 6 months indicated that there were no significant differences in radiological or clinical (except for tourniquet time, which was greater with the mini-midvastus approach) outcomes between the two techniques.
POSTED: THIS WEEK
Mini-midvastus & mini-medial parapatellar approach in TKA show similar short-term results
Plating may be superior to intramedullary nailing in fixation of humeral shaft fractures10 studies (randomized controlled trials (RCT) or quasi-RCTs) were included in this analysis which evaluated the use of plating and intramedullary nailing as a method of fixation in humeral shaft fractures. Overall, 439 patients were assessed all together in the included studies, with data available on nonunion, delayed union, postoperative infection, and reoperation rates at a minimum of 12 months postsurgically. Pooled results indicated that similar incidence of nonunion, delayed union and infection occurred between treatment methods. While initially reoperation rates were better with the use of plating, a sensitivity analysis found no difference between methods. Postoperative shoulder complications were less frequent with plate fixation.
POSTED: THIS WEEK
Plating may be superior to intramedullary nailing in fixation of humeral shaft fractures
Low-intensity pulsed ultrasound elicits faster bone healing after forearm osteotomy27 patients requiring forearm osteotomy (ulnar shortening or radial shortening osteotomy) were randomized to determine the effect of low-intensity pulsed ultrasound (LIPUS) on bone healing following surgery. Patients were allocated to groups of either postoperative LIPUS therapy or no LIPUS therapy, and were followed-up for up to 24 weeks. Main outcome was radiographic determined bone healing, along with clinical outcome using the Modified Mayo Wrist Score. Results at final follow-up found that significantly faster cortical and endosteal healing occurred in the group who underwent LIPUS therapy, and that both groups experienced a similar improvement in clinical outcome.
POSTED: THIS WEEK
Low-intensity pulsed ultrasound elicits faster bone healing after forearm osteotomy
THA: Similar improvement between ceramic-on-ceramic and ceramic-on-polyethylene bearings92 patients were randomized to evaluate the outcomes of total hip arthroplasty with either ceramic-on-ceramic or ceramic-on-[highly-crosslinked-polyethylene] bearings. Patients were allocated to receive either articulation type, and were followed-up for 5 years. The results indicated that groups did not significantly differ, and both groups experienced significant improvement in pain, function, stiffness and health status one year following surgery that was maintained until final assessment at 5 years. There was also no difference between groups for complication/revision rate.
POSTED: THIS WEEK
THA: Similar improvement between ceramic-on-ceramic and ceramic-on-polyethylene bearings
ACL reconstruction: No increased risk of adverse outcome with early or delayed surgeryEight studies (4 randomized control trials and 4 cohort studies) were included in this analysis which investigated the impact of early versus late surgery on stiffness outcomes of anterior cruciate ligament (ACL) reconstruction. Adverse outcomes of arthrofibrosis, stiffness, or range of motion deficits were reported for a minimum of one year postoperatively in the included studies. The results of the analysis indicated that surgery characterized as either early or delayed there did not increase the risk of adverse stiffness outcomes.
POSTED: THIS WEEK
ACL reconstruction: No increased risk of adverse outcome with early or delayed surgery
Comparable outcomes in quality of life with/(out) partner violence screening intervention2708 English- or Spanish-speaking women were randomised to undergo an intervention involving a computerized partner violence screening with a partner violence resource list, an intervention with just a partner violence resource list, or a control group with neither. The primary outcome was health-related quality of life. The results indicated that no significant differences were seen between the three groups on the outcome of quality of life at the one-year follow-up.
POSTED: THIS WEEK
Comparable outcomes in quality of life with/(out) partner violence screening intervention
Osteoinductive gel: Faster clinical and functional outcomes in hip replacement120 patients undergoing hip replacement surgery were randomized to have their implant coated with osteinductive gel or to not be coated with any substance before implant fixation. A mean follow up of 16 months was conducted to compare the gel’s effect on operating time, blood loss, clinical and functional results of the procedure. Although the gel increased the surgical time, it significantly reduced blood loss and increased clinical and functional recovery within 6 months.
POSTED: THIS WEEK
Osteoinductive gel: Faster clinical and functional outcomes in hip replacement
PRP does not improve healing or functional outcome in Achilles tendon rupture30 patients presenting with an acute Achilles tendon rupture were included in this randomized trial to investigate the effects of platelet-rich-plasma (PRP) in tendon healing. Patients were randomized to receive 10 ml of autologous PRP injected through a cannula into the rupture site following repair or repair with no additional treatment. Mechanical (E-modulus) and functional (heel raising index) outcomes were measured over a one year period. There were no differences in mechanical outcomes between the groups over the 1 year period, and both groups exhibited significant functional deficits compared to the uninjured limb.
POSTED: THIS WEEK
PRP does not improve healing or functional outcome in Achilles tendon rupture
Autologous platelet gel does not have a clinically relevant effect in TKA40 patients scheduled to undergo total knee arthroplasty (TKA) were randomized to receive adjunctive treatment with autologous platelet gel (APG) or no adjunctive treatment (control) to investigate haemostatic, healing and functional benefits. Throughout the hospital stay, APG use resulted in smaller haematomas, less pain on 3rd day, no wound healing complications, and shorter hospital stay. The findings, however, were marginal and not clinically significant.
POSTED: THIS WEEK
Autologous platelet gel does not have a clinically relevant effect in TKA
Posterolateral lumbar fusion: no difference in fusion rates with addition of platelet glue67 patients who underwent single-level decompression and instrumented posterolateral lumbar fusion were randomly treated with either artificial bone expander and local laminectomy autograft only or in conjunction with platelet glue (a combination of platelet gel and fibrin glue). Outcomes assessed were fusion rates (assessed using radiography), postoperative bleeding, and clinical outcomes (assessed using the MacNab criterion). Results indicated that there was no significant difference in fusion rate, postoperative bleeding, and clinical outcomes between the two groups at the 2 year follow-up.
POSTED: THIS WEEK
Posterolateral lumbar fusion: no difference in fusion rates with addition of platelet glue
Similar reduction in plantar heel pain with autologous blood, peppering, or corticosteroid45 patients suffering from plantar heel pain randomly received corticosteroid injections, autologous blood injections, or treatment using the peppering technique. Pain and functional outcomes (assessed using VAS and the American Orthopaedic Foot and Ankle Society's rear foot score) were assessed at a 6 month follow-up. Results indicated a significant improvement in VAS and rear foot scores for all groups from baseline measures, however there were no difference observed in the degree of improvement between the 3 groups.
POSTED: THIS WEEK
Similar reduction in plantar heel pain with autologous blood, peppering, or corticosteroid
Effect of autologous platelet gel on cervical spine surgery depends on spinal condition50 patients (81 disc levels) undergoing anterior cervical surgery were randomized to treatment with or without platelet concentrate, in order to determine whether the autologous platelet gel was effective in promoting early fusion. Following assessments over a 2 year period, results indicated that when patients were grouped together based on surgical indication, fusion rates at 12 weeks were significantly higher in patients with degenerative disc disease in the Platelet Gel group, compared to those in the Control group. However, this was not the case for patients with herniated discs; it was the Control group who had significantly higher fusion rates at both 6 and 12 weeks, in comparison to the Platelet Gel group for this patient population.
POSTED: THIS WEEK
Effect of autologous platelet gel on cervical spine surgery depends on spinal condition
Addition of triamcinolone to viscosupplementation improves short-term pain and function104 patients with knee osteoarthritis were randomized to examine whether the addition of triamcinolone to viscosupplementation would improve pain and function in the short- (1 week) and long-term (24 weeks) in comparison to viscosupplementation alone. Patients received either a single injection (6 mL) of hylan GF-20 or a single injection of hylan GF-20 (6 mL) with 1 mL of triamcinolone hexacetonide. The assessment at 24 weeks revealed that the addition of triamcinolone improved pain and function in the first week, but displayed no improvements thereafter.
POSTED: THIS WEEK
Addition of triamcinolone to viscosupplementation improves short-term pain and function
Autologous platelet gel not effective in lowering recovery time/pain after toenail surgery35 patients (70 feet) undergoing bilateral ingrown hallux nail surgery were randomized to receive either autologous platelet gel (APG) or standard treatment care postoperatively in order to determine the efficacy of APG in wound healing. Following evaluations over a 1 month period, results indicated that although patients receiving APG experienced a shorter recovery time and less pain than the control group, the differences were not significant. Moreover, toe inflammation was slightly greater in the experimental group, but this was also not significant.
POSTED: THIS WEEK
Autologous platelet gel not effective in lowering recovery time/pain after toenail surgery
TKA: No benefit of spray-application PRP for wound healing, pain, and function102 patients scheduled for total knee arthroplasty due to osteoarthritis of the knee were randomized to determine the efficacy of autologous blood platelet concentrate on wound healing following surgery. Patients were allocated to receive a spray application of platelet-rich plasma (PRP) to the wound site prior to closure or to a control group receiving no PRP application. Follow-up was conducted for up to 3 months post-operatively for outcomes of wound healing, pain, and function. Wound healing at 2 weeks was found to be significantly better in the control group, with a higher proportion of control patients achieving total closure. Patients who received PRP also displayed no benefits in regards to pain and function.
POSTED: THIS WEEK
TKA: No benefit of spray-application PRP for wound healing, pain, and function
Bone healing non-significantly longer with PRP bone substitute graft25 patients with varus deformity undergoing medial opening wedge high tibial osteotomy of the knee were randomized to determine the efficacy of platelet-rich plasma (PRP) combined with a biological graft of bone marrow aspirate compared to an autologous iliac graft. Participants were allocated to receive either the biological graft, or the gold-standard autologous iliac bone graft, and were followed-up for 24 weeks postoperatively. Kaplan-Meier estimates indicated that bone healing took longer in those who received the PRP graft, but the difference between groups was not significant. By the end of the 24-week study period, consolidation was observed in 10 of the 11 patients who received the biological graft compared to all patients who were treated with the iliac bone graft.
POSTED: THIS WEEK
Bone healing non-significantly longer with PRP bone substitute graft
Efficacy of platelet-rich plasma in the treatment of rotator cuff tearsSeven ACE Reports (all randomized controlled trials) were identified from the OrthoEvidence database assessing the efficacy of platelet-rich plasma (PRP) versus control in the treatment of rotator cuff tears. Result are presented for Constant scores, University of California (UCLA) scores, American Shoulder and Elbow Surgeons (ASES) scores, Simple Shoulder Test (SST) scores, Sugaya classification, and the incidence of retear. Qualitative descriptions were provided for Visual Analog Scale (VAS) pain scores and range of motion (ROM). The results indicated that PRP treatment provided favourable Constant scores at 12 months. Otherwise, the remaining poolable outcomes displayed similar results amongst treatment and control groups. Evaluations of ROM provided superior results in support of PRP treatment. This review exhibited an inconsistency in the efficacy of PRP in treatment of rotator cuff tears warranting the need for further research with uniform outcome reporting.
POSTED: THIS WEEK
Efficacy of platelet-rich plasma in the treatment of rotator cuff tears
OrthoEvidence Review: Operative vs nonoperative treatment for displaced clavicle fractures13 ACE reports (4 reviews/ meta-analyses) were included from the OrthoEvidence database that compared operative versus nonoperative or operative versus operative treatments for displaced midshaft clavicle fractures. The included trials were all randomized control trials (RCTs). The findings of this review demonstrated that surgical procedures led to a lower rate of nonunion and malunion with better functional outcome when compared to nonoperative treatment. In regards to comparisons of operative treatments, no optimal surgical procedure - between plate fixation, nailing, and pin fixation - could be determined based on union rates and functional outcome. The results of this review highlighted the need for standardized outcome reporting within the literature to improve comparisons between trials.
OrthoEvidence Review: Operative vs nonoperative treatment for displaced clavicle fractures
A trend for favourable outcomes with the use of PRP for rotator cuff lesions39 patients with a lesion of the supraspinatus tendon were randomized to receive either platelet-rich plasma (PRP) injections or dry needling to determine the comparative efficacy of the treatments for rotator cuff pathology. Follow-up was conducted for 6 months following the second injection, which took place 4 weeks after the first injection. Analysis at final follow-up indicated that total score on the Shoulder Pain and Disability Index was significantly better in the PRP group; however significance did not remain when pain and disability subscales were assessed individually. Improvement in range of motion was consistently higher at 3 and 6 months in the PRP group, and reached significance in forward flexion and internal rotation.
A trend for favourable outcomes with the use of PRP for rotator cuff lesions
rhPDGF-BB (Augment) is a safe alternative to autologous graft in foot and ankle fusion20 patients requiring hindfoot fusion were randomized to receive either a biosynthetic bone graft substitute (Augment Bone Graft, a recombinant form of platelet-derived growth factor (rhPDGF-BB)) or an autologous bone graft (ABG), in order to compare safety and efficacy between the two graft types. The results of this study suggest the biosynthetic bone graft is a safe and efficacious alternative to ABG, which could provide improved outcomes for future patients undergoing procedures requiring bone grafts if this treatment option is incorporated in to common practice.
rhPDGF-BB (Augment) is a safe alternative to autologous graft in foot and ankle fusion
PRP does not improve tendon structure in chronic midportion Achilles tendinopathy patients54 patients with chronic midportion Achilles tendinopathy undergoing an eccentric exercise programme were randomized to receive either a platelet-rich plasma (PRP) injection or a saline injection (placebo), in order to determine whether PRP injections would result in enhanced tendon structure and neovascularisation that could be observed through ultrasonographic methods. Following evaluations over a 24 week period, the results indicated that no significant differences existed in neovascularisation scores between groups and that PRP injections did not contribute to improved tendon structure.
PRP does not improve tendon structure in chronic midportion Achilles tendinopathy patients
Jumper's Knee: PRP improves mid-term function and pain relief compared to ESWT46 athletic patients suffering from jumper's knee (greater than 3 months) were included in this trial to compare the efficacy of both Platelet-Rich Plasma (PRP) and Extracorporeal shock wave therapy (ESWT) in this patient population. Pain, function and general treatment effectiveness were measured over a 12 month period. Both treatments were able to provide significant improvements in pain and function at all time points. However, PRP provided greater improvements in pain and function at 6 and 12 months when compared to the ESWT.
Jumper's Knee: PRP improves mid-term function and pain relief compared to ESWT
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