Platelet Rich Plasma Therapy seeing widespread use

The public, commerical, and medical community are becoming increasingly aware of the potential promise of platelet rich plasma, growth factors, and stem cell therapy. While I use PRP for tendon and cartilage disorders, physicians in South Africa have been using PRP for facial rejuvination and wrinkles by potentially stimulating collagen synthesis.

http://www.internationalshoulderjournal.org/article.asp?issn=0973-6042;year=2007;volume=1;issue=2;spage=64;epage=73;aulast=du
Also research is being conducted to treat alopecia (hair loss) by stimulating follicular growth. Adult Stem cells the precusor for these proteins may hold the most promise.

It is my opinion that there is much more to be learned regarding PRP. However ultimately we may find that isolating individual growth factors with specific responsibilities may be more effective. Researchers are already working on isolating individual growth factors for specific tasks like cartilage regeneration etc.

Dry Needling effective for Plantar Fasciitis

With musculoskeletal ultrasound to examine the heel (much like looking obstetrician's use to examine a fetus), physicians are able to accurately target heel pain.

With the advancement of technology we are able to further our understanding of disease as well as offer innovative treatments.

At the December 08 annual Radiological Society of North America, Luca M. Sconfienza, MD, from University of Genoa in Italy demonstrated 95% efficacy with dry needling followed by cortisone.

Plantar Fasciitis is one of the most common foot problems affecting 1 million people. Patients typically complain of inner heel pain with stiffness in the morning and later throughout the day with weight bearing.

44 patients were treated who had previously failed extra corporeal shockwave therapy. Shock wave therapy works by a similar means through creation of micro trauma that increases blood flow and promotes healing in a deficient ligament or tendon.

A similar procedure is done with platelet rich plasma therapy, which involves needling of the thickened and oxygen deficient plantar fascia under ultrasound guidance. But rather than using cortisone, the patients own growth factors (extracted from their arm from a blood draw) are injected into the area of injury to promote natural healing. Unlike cortisone, platelets & growth factors have no reported ill effects of tendon tearing or rupture, but rather regenerate the tissue.

http://www.healthimaging.com/index.php?option=com_articles&view=conference&id=publication:37:article:15307:section:1&division=hiit

Stem cell therapy for soldiers in battle?

Military medics often struggle to get donated blood to soldiers in battle, which can take weeks to deliver. Also hospitals in the US have seen a sharp drop in donated blood resulting from risks associated with hepatitis and other disease. This supply shortage has increased the cost of transfused blood to hospitals which are already suffering in a recession.

Researchers at the Defense Advanced Research Projects Agency (DARPA) were recently awarded a large grant to implement technology developed from John Hopkins University using nanofibers to mimic marrow to produce blood and stem cells. Theoretically this would decrease the need for transfusions and decrease the costs associated with them.

This work may contribute the the global understanding & usage of stem cells to help save lives and cure disease. Clearly in our lifetime we will see more and more stories on stem cells and growth factors unlocking some of the chains of disease.
http://www.popularmechanics.com/science/health_medicine/4296060.html

Dr Steven Sampson launches new web site: www.orthohealing.com

We are pleased to announce that our new web site has launched! Checkout www.orthohealing.com to read more about our practice. We want this website to be a resource for you, so please feel free to drop us an e-mail and let us know what you would like to read about!

This site replaces the former www.prpinjection.com

Barack Obama Pledges to reverse Bush Administration Policy on Stem Cell Research

With the election of a new president, there will certainly be change. Recently in the Washington Post & CBS news, it was reported that Barack Obama intends to reverse the Bush policy on stem cell research. It is believed amongst the scientific community that stem cells offer abundant potential for challenging conditions including parkinson's disease and osteoarthritis among others. However, adult rather than embryonic stem cells are available with current technology and have little controversy associated with their use. The only problem is that harvesting them requires inserting a metal rod into the bone marrow to extract it. Hopefully, soon we will be able to draw adult stem cells from peripheral blood (drawing blood from the arm & processing stem cells). Clearly the orthobiologic field is growing, and we will learn more about the promise of stem cells in the near future whether adult or embryonic cells are utilized.

http://www.cbsnews.com/stories/2008/11/09/politics/washingtonpost/main4586410.shtml

Platelet Rich Plasma used on Los Angeles Dodger Pitcher Takashi Saito

PRP or Platelet Rich Plasma has seen increased use in professional athletes. Recently, Takashi Saito, a star pitcher for the LA dodgers suffered a tear of his ulnar collateral ligament. In efforts to accelerate healing and to avoid a Tommy John surgery, Saito elected to receive the prp injection graft. As a result, He was able to pitch in the playoffs without limitations.

We have treated other professional athletes with similar results. PRP can be thought of in both high level athletes to accelerate recovery or in chronic non-healing injuries that have persisted despite conservative treatment or even surgery.

Hopefully as more high level athletes receive this treatment, it will increase awareness about this procedure that has very little downside and tremendous potential.

http://www.latimes.com/news/printedition/front/la-sp-dodfyi3-2008oct03,0,1021170.story

Also, Stanford University Football players have been receiving platelet Rich Plasma injection grafts with success.

http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2008/09/30/SPL7138OOQ.DTL

There is currently a multi-center FDA study on tennis elbow that will be enrolling more patients soon.
www.orthohealing.com

Also we are working on another PRP knee arthritis study based on the previously successful pilot study.

New Platelet Rich Plasma Studies Underway

As testament to the growth in the biologic sector, numerous orthobiologic companies worldwide are funding research & are obtaining grants with PRP use.



Applications of study include plantar fasciitis, achilles tendinosis, congestive heart failure, peripheral vascular disease, systemic sclerosis (scleroderma), knee MCL tears, perodontal tissue, aortic aneurysms, coronary artery bypass, tennis elbow, and rotator cuff tears among others. I am currently conducting research specifically on knee arthritis.
www.orthohealing.com

http://clinicaltrials.gov/ct2/results?term=platelet+rich+plasma

http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=1420

http://clinicaltrials.gov/ct2/show/NCT00198185?cond=%22Tendon+Injuries%22&rank=1

http://clinicaltrials.gov/ct2/show/NCT00761423

LA Times article emphasizes non surgical approach to arthritis

ar

Following the well publicized NEJM article suggesting the ineffective role of arthroscoopy in arthritis, many are looking for alternative treatments that are cost effective with little risk. This article from the LA Times highlights some options including an exercise program, physical therapy modalities, and weight loss. While I agree that physical therapy is beneficial, as is maintaining an active lifestyle; often we need to address the internal biochemical environment of the joint. This may be achieved with Platelet Rich Plasma Therapy. Our knee arthritis clinical trials continue to show promising results in most cases. I have the 3 mo data in & I am collecting 6 mo data in a few weeks from now. These results will be published.

http://www.latimes.com/features/health/la-he-knees22-2008sep22,0,42582.story

New knee arthritis study suggests arthroscopies are ineffective

Despite the predominance of knee arthritis in the US, there are few good options for patients hoping to relieve pain & improve function. Physical therapy can help to increase muscle tone to the quadriceps muscles to reduce excessive workload on the joint. Also inflexible muscles can be stretched to restore the normal kinetic chain to reduce pain & prevent further aggravation of symptoms. Orthotics & braces may decrease the mechanical forces that are adding stress on the joint. However these treatments will not influence the underlying inner cartilage defects and biochemical environment.

Knee arthroscopies are quite popular and certainly have a role in particular cases including severe meniscus and ACL tears. However in a recent study in the New England Journal of Medicine, there was no demonstrable benefit of knee arthroscopies for moderate to severe knee arthritis compared to physcial therapy and medications. 92 surgical patients and 86 controls (Physical therapy & medications) were compared over 2 years.


http://content.nejm.org/cgi/content/short/359/11/1097

The article was reviewed recently in the LA Times.
http://www.latimes.com/news/nationworld/nation/la-sci-knee11-2008sep11,0,1198164.story

This article should raise awareness that we need to develop innovative approaches to maximize healing in an increasingly active population. Over 27 million Americans have osteoarthritis.

We are performing Platelet Rich Plasma Injection Grafts in hip and knee arthritis with encouraging results. The field of orthobiologics is rapidly growing and promises to deliver new approaches to treating tendon and cartilage disorders. In my practice we are treating meniscal tears immediately to accelerate healing. Many patients do not need an arthrocsopy after 2 months of the PRP graft and physical therapy. By potentially avoiding surgical meniscal repairs, we hope to reduce the incidence of subsequent arthritis. We are conducting studies to further refine the treatment to achieve a maximal result.

Dr Steven Sampson publishes new Platelet Rich Plasma article

My PRP review article is now published in the Current Reviews in Musculoskeletal Medicine. http://www.springerlink.com/content/5708408818n30275/ The online version is available, and the printed version is coming soon. The article includes nearly 50 literature sources and provides a comprehensive overview regarding platelet rich plasma usage in orthopaedics and sports medicine. Also, the review discusses the promising realm of orthobiologics and describes experiences with using platelet rich plasma for cartilage disorders and osteoarthritis.

I have been conducting research on arthritis with encouraging results so far. I am planning on collaborating with other leading physicians and publishing many more articles to advance the field of orthobiologics.

New Platelet Rich Plasma (PRP) Study on Tennis Elbow (Lateral Epicondylitis)

Gosens & Sluimer from the Netherlands, just reported on a prospective, double blinded, randomized study comparing PRP to cortisone injections in the treatment of 100 patients with tennis elbow. They used a visual analog pain score (1-10) & a DASH score to measure treatment response by 24 weeks. Both groups demonstrated initial improvement. However, by 24 weeks the cortisone group had a recurrence of pain whereas the PRP group continued to have improved pain scores. 1 and 2 year follow up results will be reported in the future.

This article originated from St. Elisabeth Hospital, Tilburg, the Netherlands.

Prior research has showed that after 4-6weeks tendons are no longer inflammed, but rather become thickened, scarred, & fibrotic with poor blood supply. Therefore at this point the proper nomenclature is "tendinosis" not tendinitis. With this understanding we try to facilitate healing by increasing blood flow and breaking up scar tissue.

New FDA Approved Study with Adult Bone Marrow Stem Cells in Vascular Disease

Using One's own adult stem cells taken from bone marrow, researchers are studying the effects of potentially preventing amputation in ischemic (poor blood supply)limbs. Doctors do a minimally invasive procedure obtaining stem cells, then much like PRP or platelet rich plasma they increase the concentration and then inject it. Doctors are injecting multiple sights just beneath the tissue in the blood flow deprived extremity. We look forward to following this study & the results that follow.

http://www.biomet.com/patients/clinical_recruitment_padstudy.cfm

Adult Stem Cells for Arthritis?

Perhaps the next frontier beyond PRP is Stem Cells. While the topic is the subject of much controversy politically, technology now allows us to utilize adult stem cells opposed to embryonic cells to treat disease.

Stem Cells are the birthplace of platelets rich in healing properties, which can potentially program cells to regenerate tissue & cartilage. Currently stem cells can be retrieved via embryo (controversial in US), umbilical cord, bone marrow, peripheral blood, & in the near future adipose (fat) cells via liposuction.

Peripheral blood, or simply drawing blood from a patient's arm is the least invasive & most promising method. Patients require a shot or medication to release stem cells from the marrow to the blood stream. It can then be processed & used for injection. In the future patients may have the option to store unused stem cells for future use as well.

Stem cells are being used in the US mostly for cancer patients to assist in recovery from the ill effects of chemotherapy. A few practitioners are using them orthopaedically with reportedly good results in arthritis. Internationally there are centers where patients seek alternative treatment to serious diseases like spinal cord injury, multiple sclerosis, and ALS.


There is an adult stem cell organization which lists numerous articles & personal stories.

www.adultstemcelleducation.com