Zimmer introduces Chondrofix Osteochondral Allograft

Zimmer introduces Chondrofix Osteochondral Allograft

Let us see the results.

PRP an unproven option, agree forum experts

PRP an unproven option, agree forum experts

By Mary Ann Porucznik

An international group of orthopaedic surgeons, clinician scientists, and researchers agreed that, for many orthopaedic conditions, administration of platelet-rich plasma (PRP) may be an option, but its efficacy is unproven. The participants of the 2011 PRP Forum also endorsed the development of standards in the manufacture of PRP, noted that PRP may be contraindicated in some conditions, and called for the establishment of a study group to follow up on the other recommendations resulting from the session.

Attendees discussed the applicability of PRP in the following areas:

• treatment of acute soft-tissue injuries, such as Achilles tendon rupture and rotator cuff repair
• chronic tendinopathies such as plantar fasciitis or medial/lateral epicondylitis
• augmentation of soft tissue or bone such as in spinal fusion
• treatment of cartilage defects such as those resulting from osteochondral lesions or osteoarthritis.

The 2011 PRP Forum was staged by AAOS Now, and cochaired by AAOS Now Editor-in-Chief S. Terry Canale, MD, and AAOS Now editorial board member Frank B. Kelly, MD. It brought together approximately 50 of the most knowledgeable and experienced clinicians and researchers in the field of PRP therapy, including Steven P. Arnoczky, DVM; Freddie H. Fu, MD; Wellington Hsu, MD; Elizaveta Kon, MD; Allan K. Mishra, MD; Nicola Maffulli, MD, PhD; Pietro Randelli, MD; and Scott A. Rodeo, MD. It combined a series of presentations, followed by break-out group discussions, resulting in a series of recommendations for future study of PRP.

All PRPs are not the same
In opening the forum, Dr. Arnoc-zky noted that “All PRPs are not the same, and we have to be aware of what we are putting in the patient.” Although PRP is a concentrated, autologous preparation developed from the patient’s own blood, some concentrations may contain double the number of platelets while others may contain five or ten times the number of platelets. The proportion of white blood cells, growth factors, and other compounds such as thrombin can also affect the compound.

The problem, however, is that “we don’t know how PRP works,” admitted Dr. Arnoczky. Most of the published literature on the efficacy of PRP in treating orthopaedic conditions that range from acute rotator cuff tears to chronic Achilles tendinitis have not specified the formulation used. The variation in composition does not enable scientists to compare results… “we’re talking apples and oranges and bananas,” said Ramon B. Cugat, MD.

Dr. Mishra presented a potential classification system for PRP, based on the presence or absence of white blood cells, the concentration of platelets, and the activation status. He noted that much current use of PRP in orthopaedics is patient-driven and based on reports of its use in elite athletes such as Tiger Woods and Cliff Lee.

Most major league sports governing bodies (National Football League, Major League Baseball, and National Basketball Association) have approved the use of PRP on athletes, and the World Anti-Doping Association recently removed platelet-derived preparations from its list of prohibited substances and methods, based on the lack of current evidence concerning the use of PRP for performance enhancement.

At the end of the day, an informal survey of participants found most in agreement that PRP would be an option, particularly if conservative treatments have failed and the next step would be surgery.

“PRP is a simple concept,” concluded Dr. Mishra, “but it is surrounded by a complex set of questions that are still unanswered.”

JBJS | Platelet-Rich Plasma Differs According to Preparation Method and Human Variability

JBJS | Platelet-Rich Plasma Differs According to Preparation Method and Human Variability
The content and concentrations of platelets, white blood cells, and growth factors for each method of separation differed significantly. All separation techniques resulted in a significant increase in platelet concentration compared with native blood. Platelet and white blood-cell concentrations of the PRP_HP procedure were significantly higher than platelet and white blood-cell concentrations produced by the so-called single-step PRP_LP and the so-called two-step PRP_DS procedures, although significant differences between PRP_LP and PRP_DS were not observed. Comparing the results of the three blood draws with regard to the reliability of platelet number and cell counts, wide variations of intra-individual numbers were observed.

JBJS | Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis

JBJS | Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis
Twenty-three randomized trials and ten prospective cohort studies were identified. There was a lack of consistency in outcome measures across all studies. In six randomized controlled trials (n = 358) and three prospective cohort studies (n = 88), the authors reported visual analog scale (VAS) scores when comparing platelet-rich plasma with a control therapy across injuries to the acromion, rotator cuff, lateral humeral epicondyle, anterior cruciate ligament, patella, tibia, and spine. The use of platelet-rich plasma provided no significant benefit up to (and including) twenty-four months across the randomized trials (standardized mean difference, −0.34; 95% confidence interval [CI], −0.75 to 0.06) or the prospective cohort studies (standardized mean difference, −0.20; 95% CI, −0.64 to 0.23). Both point estimates suggested a small trend favoring platelet-rich plasma, but the associated wide confidence intervals were consistent with nonsignificant effects.

Platelet rich plasma returned most athletes to play after partial ulnar collateral ligament tears

Platelet rich plasma returned most athletes to play after partial ulnar collateral ligament tears

Brophy and colleagues used data from the prospective Multicenter ACL Revision Study (MARS) to identify 725 revision ACL surgeries in patients with a mean age of 25 years.

“Knees undergoing ACL reconstruction have been shown to have a high incidence of chondral injuries in studies previously published […], however the risk factors for these lesions in this cohort are not well understood,” Brophy said. “Our hypothesis was that previous partial meniscectomy would be associated with a higher incidence of chondral lesions at the time of revision ACL reconstruction, but that meniscal repair would not be associated with the chondrosis.”

Of the group, there were 421 male patients. The investigators examined the data for Grades II, III and IV chondral lesions. Patients that underwent previous partial meniscal surgery and were undergoing ACL reconstruction had a higher grade of chondral lesions than patients who underwent no meniscal surgery.

“The reason for meniscal repair not being associated with chondrosis are not clear,” Brophy said. “Certainly, differences in underlying injuries to the knee, either at the time of recurring ACL injury, or previous injury to the knee. Although it is certainly a possibility that repair is perhaps somewhat protective, but certainly not to be precluded from association in this study.”

Dubai Duty Free Tennis Classic-DBAJ Official Healthcare Provider-Dr. William Murrell Chief Tournament Physician

To Dubai Bone and Joint Center (DBAJ) begins its inaugural coverage of the Dubai Duty Free Tennis Classic as Official Healthcare Provider. Dr. William Murrell, Orthopaedic Sports Medicine will serve as Chief Tournament Physician. The tournament will start today, will continue until the finals on 25 Feb, after which the men's ATP tournament will commence.

National Conference on Sports Medcine and Rehabilitation

Tommorow, 16 Feb, I will be giving a lecture at Gulf Medical University in Ajman for the National Conference on Sports Medcine and Rehabilitation. Lecture will be about Arthroscopy in Orthopaedic Sports Medicine

New stem cell-rich collagen paste repairs defects with success

New stem cell-rich collagen paste repairs defects with success