New Acupuncture Literature Supports Acupuncture in Low Back Pain

Although acupuncture has been used for thousands of years, it is difficult to study under or western system of evaluating research. However a large study from Germany needled over 1100 patients and found favorable results. 47% improved with acupuncture versus 27% in conventional treatments (Physical Therapy Meds etc.). Interestingly, 42% of sham acupuncture (fake acupuncture where the needles were placed in the skin at random non-acupuncture points had relief as well. This insn't too suprising to acupuncturists, as the needling itself stimulates a natural reaction in the body releasing endorphins, increasing blood flow, and temperature.

Acupuncture is appealing because it is safe and focuses on treating the patient as a whole, rather than just a knee or a hip etc. For example when we treat a patient with knee arthritis we place needles & electricity around the knee, but also around the hands, ear, feet, scalp etc to address the whole person to adress other issues like fatigue and anxiety. This invloves some unorthodox interviewing of the patient inquiring about childhood illness & personality details.

The East believe that illness is a result of blocked Qi (chi) that normally flows from teh feet up to the head, and back down to the feet in a cycle. Acupuncture promotes the flow of qi.

Electroacupuncture with a knee arthritis may be combined in a PRP protocol to maximize benefits.

Heading to PRP Ultrasound Conference Nov-2nd-3rd, 2007

On Nov 2nd & 3rd, I will be at a PRP course in Ohio. To my knowledge it is the first of it's kind in the US. Several field leaders and those Physicians interested in learning about PRP will gather there to exchange ideas and further our understanding of PRP. Also, there will be needle guided ultrasound tutorials. Musculoskeletal ultrasound is being used increasingly by docs performing PRP injections. I have performed some injections under ultrasound with enhanced ability to guide the needle to precise areas of injury. I will post info following the course.

New Spine article on biologics "Orthokine" Use in Lumbar Epidurals for Sciatica

A common treatment for a herniated Disc or "Sciatica" that fails physical therapy and conservative treatment is an epidural steroid injection. Nowadays they are performed under an x-ray machine, called fluroscopy which ensures proper needle placement and safety.

A study from Spine compared steroids/cortisone which is commonly used in epidurals to decrease nerve inflammation with Orthokine. http://www.orthokine.com/Orthokine is a biologic agent known as a Cytokine. It specifically blocks Interlukin-1, which plays a role in inflammation and pathology. Similar to PRP, whole blood is drawn from a patient and placed in a centrifuge aftrewards. However there is an additional step with incubation of the processed blood for 24hrs which creates IL1-RA an antagonist that blocks pain/inflammation.

The study suggests that after 3 months of receiving a series of 3 injections, those with Orthokine injections had more dramatic decreased pain scores than those with cortisone. Furthermore, there are less adverse effects associated with autologous blood versus steroids.

http://www.spinejournal.com/pt/re/spine/abstract.00007632-200708010-00002.htm;jsessionid=HflXqpy0GQGZYyvc3GpvY1NQ4QYjnk1xjNGmlLqmQpXN1BmjGKZV!1071114923!181195629!8091!-1

Orthokine and PRP are part of an emerging industry that combine modern technology while maximiizing the body's natural ability to heal itself. This field is known as Orthobiologics.

New Study on PRP use on Rabbit Cartilage

In the Journal of Oral & Maxillofascial Surgery, September 2007, A
Cartilage cells, (chondrocytes) were harvested from a rabbit ear and was added to PRP and injected into rabbits. After 2 months, histological slides and MRI suggested increased cartilage production.

PRP is seeing increased usage in cartilage defects, with many docs reporting promising results. However studies like this may lead to a more refined approach to PRP and knee osteoarthitis. In time, individual growth factors may be filtered out and applied for specific indications. For now, PRP contains a "cocktail" of potent healing properties. This exciting new field is termed, "Orthobiologics."

http://www.joms.org/article/PIIS0278239106021070/abstract

Dental Applications of Platelet Rich Plasma

Early roots of PPR use lie in Dentristy and Plastic Surgery. Initially, it was thought that platelets act exclusively by forming wound clots. However, we have learned that PRP also heals soft tissue.

Below is a link to dental applications.

http://jada.ada.org/cgi/content/abstract/133/10/1383

Furthermore there are few textbooks on PRP. This book was written by Robert E. Marx, a pioneer of PRP usage.

http://www.amazon.com/Dental-Craniofacial-Applications-Platelet-Rich-Plasma/dp/0867154322

Racing Horse Treated with PRP and Hyperbaric Oxygen

PRP has been used in Vetrinary medicine as well. Recent studies have shown that PRP strengthens and heals tendons and ligaments that are frequently injured in race horses. PRP has been modified for horse application.

http://www.equinesite.com/articles/modules.php?name=News&file=article&sid=1178

A case report was just released documenting accelerated recovery of a professional race horse, Wearable Art.

http://www.standardbredcanada.ca/news/iss1007/wearableart1002.html

Platelet Rich Plasma Patient Education Brochure

www.smog-ortho.com/prpguide.pdf

Platelet Rich Plasma on CBS News with Katie Kouric

Our Practice (Santa Monica Orthopaedic Group) was featured on CBS Evening News recently. We treated a professional soccer player, Jonathan Bornstein with PRP to accelerate his MCL knee injury healing. We have treated several athletes with encouraging results. His story was told on CBS News. Also, one of my colleagues, Dr Michael Gerhardt was interviewed.

http://www.cbsnews.com/stories/2007/06/05/eveningnews/main2889125.shtml

Knee Arthritis Helped with Platelet Rich Plasma, Warsaw, Poland Oct 07'

- Utilization of Platelet-derived growth factors for the treatment of cartilage degenerative pathology Clinical research / Knee (Chondral and Osteochondral defects)

E. Kon, G. Filardo, M. Lo Presti, M. Delcogliano, F. Iacono, C. Montaperto, M. Marcacci; Bologna/IT
Purpose
The influence of the growth factors on cartilage repair is not yet widely studied and its application in clinics is still experimental. PRP (Platelet Rich Plasma) is a natural concentrate of autologous growth factors and actually is widely experimented in different fields of medicine. The method is simple, low cost and minimally invasive. The aim of our study is to determine the short-term effect of PRP in cartilage degenerative pathology.
Methods and Materials
30 symptomatic patients (40 knees) were treated with autologous PRP intra-articular injections for degenerative cartilage pathology. Mean age of the patients was 51 years (range:35y to 80y). 3 injections were performed every 3 weeks. All patients were clinically evaluated at the end of the treatment and at 6 months follow up. IKDC, SF36, EQ-VAS, scores were used for clinical evaluation and patient stisfaction and functional status were also recorded.
Results
Statistically significant improvement of all scores was detected after treatment and was maintained at 6 months. Subjective IKDC evaluation showed a significant score enhancement from 37,9 before the treatment to 59,0 after the treatment. Significant correlation of clinical outcome with patients age was found. While the group of patients less then 60 years old have shown 85% of improvement, the group of patients over 60 showed only 30% of improvement of clinical outcome.

Conclusions
Our study have demonstrated a positive effect of treatment of degenerative cartilage pathology with Platelet-derived growth factors in middle-age patients (<60y) at short term. Medium-long term studies are needed to confirm the durability of this treatment.


ICRS - International Cartilage Repair Society.

Knee Cartilage Cell Stimulation with Platelet Rich Plasma, Warsaw Poland, Oct 07'

Effects of autologous platelet-rich plasma on the metabolism of human articular chondrocytes
K. Nakagawa1, T. Sasho1, M. Arai1, S. Kitahara1, S. Ogino1, Y. Wada2, H. Moriya1; 1Chiba/JP, 2Ichihara/JP

Purpose

Platelet-rich plasma (PRP) is a fraction of plasma in which platelets are concentrated and is reported to be utilized as a source of multiple growth factors. Recent basic studies have shown that allogenic PRP has a promotive effect on chondrocyte metabolism. For the clinical application of PRP to cartilage defects, it is essential to use autologuous prepared PRP in each case. The purpose of this study was to examnie the effect of autologous PRP on adult human chondrocytes.
Methods and Materials
Fresh blood (54ml) and cartilage tissue were obtained from three patients (mean age: 70y.o.) underwent total knee arthroplasty with their consent. Platelet poor plasma (PPP) and PRP were prepared using a platelet concentration system. Chondrocytes were isolated with enzymatic digestion and cultured in monolayer. WST-8 was used for cell proliferation assay. Gene expression of types I, II collagen and aggrecan were examined with a relative quantitative real time RT-PCR assay.
Results
The concentrations of PDGF and TGF-beta1 in the PRP were much higher than those in the PPP. The WST-8 assay showed a higher absorbency in the PRP group, which reflects an enhancement of cell proliferation. PRP significantly enhanced type II collagen synthesis by human chondrocytes, while their aggrecan synthesis was inhibited.
Conclusions
We demonstrated for the first time that autologous PRP stimulated proliferation and collagen synthesis of adult human chondrocytes. PRP is easy to prepare and utilize as both soluble platelet releasate and fibrin gel. The results of this study suggested the usefulness of autologous PRP for the treatment of cartilage defects.


ICRS - International Cartilage Repair Society. http://www.cartilage.org/

New Studies on Platelet Rich Plasma and Knee Osteoarthritis

My Colleague Bert Mandelbaum MD, just returned from the (ICRS) International Cartilage Repair Society Meeting in Warsaw Poland last wk with exciting news. Two studies document efficacy & safety of PRP use in cartilage disorders of the knee. Previously the only link I was aware of connecting PRP benefits with cartilage was a study by Hunziker et al. This study links one of the growth factors in PRP, TGF-b to cartilage regeneration.

www.corronline.com/pt/re/corr/abstract.00003086-200110001-00017.htm;jsessionid=GWpFpfW1dldQXqQm2sCVGwDXkl

Also, many patients have heard of another biologic treatment being performed in Dusseldorf Germany called Orthokine. Some of our patients have unsuccessfully tried this therapy or were considering travelling to Germany before learning about what we do here in Santa Monica. www.orthokine.com www.neue-orthopaedie.de

The following studies are available on this site. (Sorry there is no direct link available yet). We are hoping to do a large knee Osteoarthritis study on PRP soon. These new studies presented in Europe suggest that the cocktail of growth factors work on stimulating cartilage cells called "chondrocytes." The study below injected 30 patients with knee OA in a series of 3 PRP injections at 3 week intervals. Patients were re-evaluated at 6 months. Patients younger than 60 years (presumably with less severe arthritis) improved 85% versus 30% for those over 60 years. This encourages further discussion regarding the use of PRP in OA as well as consideration of a series of injections.



The following were presented at the ICRS from Warsaw. www.cartilage.orgUtilization of Platelet-derived growth factors for the treatment of cartilage degenerative pathology from Bologna Italy by E. Kon, G. Filardo, M. Lo Presti, M. Delcogliano, F. Iacono, C. Montaperto, M. Marcacci;

Effects of autologous platelet-rich plasma on the metabolism of human articular chondrocytes
Basic Science / Growth factors
K. Nakagawa1, T. Sasho1, M. Arai1, S. Kitahara1, S. Ogino1, Y. Wada2, H. Moriya1; 1Chiba/JP, 2Ichihara/JP

PRP knee injection 8 wks post injection update

Well it's been 8 wks now since my infamous surfing experience & subsaquent injection. I have been doing terrific. By now, I have received a series of MRI's and an ultrasound that document decreased edema & show tendon thickening (indicating healing of my MCL ligament. Initially I had a grade II MCL sprain. Because I have my own MRI machine, I have the luxury of performing seriel studies.

Anyways, I have been attending PT weekly with Cheyanne Kane PT in West LA (good therapist). She has been using modalities including Laser which have been helpful. Also, I have Cheyanne place the laser on acupuncture points for healing and relaxation.

By now, I have been swimming, biking, & running pain free. Occasionally my knee feels a little stiff after standing or sitting for prolonged periods, but maybe a 1/10 on the pain scale. I have not taken any medications other than tylenol for a few days after the initial injection.

I will soon publish a case report on my MCL injury with PRP injection. Hopefully this will inspire other professional & recreational athletes to consider this treatment to accelerate recovery with limited negative consequences. All of our professional soccer players with MCL sprains and PRP injections are doing great.