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

New Biologics Textbook Includes Platelet Rich Plasma (PRP)

A new textbook was released by Jennifer E. Woodell-May and William S. Pietrzak which includes a chapter reviewing PRP. The chapter includes a literature review including case reports that suggest the multitude of potential applications.
One of the chapter's authors, Jennifer Woodell-May has produced insightful research regarding the role of growth factors & their concentrations.

www.springerlink.com/content/h25275w189773071/

New PRP Platelet Rich Plasma Knee Arthritis Study

We are beginning clinical trials of Platelet Rich Plasma (PRP) injections in patients suffering with knee arthritis. There is an increasing "boomer" population with earlier knee arthritis as a result from prior trauma including meniscal tears & arthroscopies with scarring and cartilage loss etc. This phenomenon is termed "chondropenia." We are searching for non-invasive alternatives to knee replacements in these active individuals.

Patients will receive a series of injections under ultrasound guidance to insure proper placement. X-rays and MRI's, are taken into account & cartilage growth will be measured on serial ultrasound evaluations. Multiple pain score measures will be recorded as well. We plan on publishing this data so that the medical community can learn more about the promising role of PRP injections in cartilage disorders.

Platelet Rich Plasma Injection for Hip Bursitis

After initially successfully injecting many patients with tendon & ligament problems, we have been expanding use of PRP to numerous regions including greater trochanteric hip bursitis among others.
A "bursa" is a small fluid filled sac that can be found in many areas that reduces friction of gliding tissues. This bursa fills with synovial fluid as a result of mechanical trauma/irritation & causes considerable pain. Specifically there is a bursa that lies on top of the greater trochanter (femur/hip bone). This pain can be debilitating. Often cortisone injections can be successful & provide temporary relief. However overuse of cortisone can cause adverse effects & should be avoided. Therefore PRP (Platelet Rich Plasma) injections under ultrasound guidance offer an appealing & safe alternative.

Below are case reports from a group in Texas that successfully injected PRP for hip bursitis.
http://www.cosociety.org/resources/200603COSnewsletter.pdf

New Platelet Rich Plasma (PRP) review article for tendon injuries and arthritis

In a Jan/Feb 08 issue of Practical Pain Management, the authors describe PRP use in tendon injuries, spine conditions, as well as hip & knee arthritis. The article emphasizes a need for agreed upon nomenclature.

An interesting concept addressed is whether a gel matrix is needed for the platelets to adhere to the target site. Because of their structure tendons & ligaments may not require the gel, however it is not known if adding calcium chloride with thrombin to the PRP is needed in joint spaces like knee & hip arthritis. Further data needs to compare the usage with gel versus without.

The article showed x-rays post prp injection with subtle smoothing of a previously arthritic femoral head (hip bone). It is not clearly known how PRP acts on arthritis, however a particular growth factor found in PRP, TGF-B has been linked to cartilage growth (chondrogenesis). Furthermore, another study showed that PRP influences hyauloronic acid production which balances cell proliferation (angiogenesis). Also, the authors suggested a possible role in serotonin decreasing pain. Lastly, utilizing "stem cells" (the birth place of platelets and their precursors)may offer the most ultimate potential.

http://www.ppmjournal.com/abstract.asp?articleid=P0801F01

http://prpinjection.blogspot.com/2007/11/new-article-on-osteoarthritis-and.html

Treatment of Achilles Tendinosis with Shock Wave Therapy

An article from Jan 08'in the JBJS (Journal of Bone & Joint Surgery), that documented low energy shockwave therapy was effective in treatment of non-healing achilles tendinosis. The randomized controlled trial showed that 64% of patients receiving shock wave(group I) were completely recovered or much improved, versus 28% of those who received an eccentric loading exercise program (group II).

The study looked at 50 patients who have had pain for > 6months & failed conservative treatments.

http://www.ejbjs.org/cgi/content/abstract/90/1/52

I have been treating many patients lately (more than 50, with various injuries including achilles tendinosis, plantar fasciitis, tennis elbow, & bicep tendonosis with favorable results. I have all patients complete questionnaires 6 weeks after their initial treatment to determine a useful role for shockwave in my practice.

Ultimately I invision a protocol implementing various modalities to maximize the body's innate ability to heal itself. Furthermore, I am exploring the potential role of hyperbaric oxygen therapy.

I will soon post results from the 150 or so shock wave treatments I have done. However, larger studies requiring double blinded methods are required so that we can learn more about shockwave therapy.

Multi Center Clinical trials of Platelet Rich Plasma Underway

Many trials are in the pipeline in efforts of obtaining FDA approval for PRP injections. There is a multi-center placebo controlled double blinded study underway looking at plantar fasciitis(heel pain) & lateral epicondylitis (tennis elbow).

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

Also, Thanks to the many patients inquiring about info on docs around the country performing PRP procedures. Feel free to contact any of those listed in the link performing this particular study. At some point I may have a list of various PRP docs out there to help patients out. Please Continue to send requests.

On another note, we are currently examining the efficacy of Platelet Rich Plasma with osteoarthritis. We are collecting objective data on all patients injected.

January 08' Platelet Rich Plasma Enhances Tendon Healing

A new article from the Journal of Cellular Physiology presented some new insights into the role of PRP in tendon healing. After injecting PRP into mice patellar tendons, accelerated healing was demonstrated. The PRP had an 8.8 times platelet concentration above baseline versus whole blood.

Circulation derived cells play a key role in tendon healing. Blood flow is very important in connective tissue regeneration. Tendons typically have a poor blood supply (only 1/3 of the amount found in muscles). This study showed increased quantity of these healing cells in the early phase of tendon repair. Unfortunately, these helpful cells normally disappear with time. Therefore prolonging their presence is advantageous. Also increased type I & III collagen and macrophages were increased; supporting that PRP promotes tendon healing

http://www3.interscience.wiley.com/cgi-bin/abstract/117880365/ABSTRACT?CRETRY=1&SRETRY=0

A need to Clarify Platelet Rich Plasma use in International athletes

A new article from the British Journal of Sports Medicine Nov 07, reviews PRP (Platelet rich Plasma) use in sports medicine. After a good thorough review, they point out that using growth factors is considered a doping violation by the WADA (World Anti-Doping agency). THE WADA created in 1999 to promote, coordinate, and monitor the fight against doping in sports. The WADA prohibits use of a particular growth factor, Insulin like growth factor (IGF-I). However scientific literature has shown that IGF-I is not increased in PRP. This misunderstanding of PRP may create an ironic situation where this cutting edge technology may be available to the weekend warrior, but not the Olympian. Keep in mind that "growth factors" are different from "growth hormones."

As PRP use increases so does the need for the scientific community to comprehend it's applications & mechanism of action. Hopefully the application of PRP will be recognized as a natural and safe alternative to promote healing in high level athletes and the weekend warrior alike.

Growth Factor Delivery Methods in the Management of Sports Injuries:The State of Play http://bjsm.bmj.com/cgi/content/abstract/bjsm.2007.040071v1

Ultrasound Guided Platelet Rich Plasma Injections

A growing number of physicians are using musculoskeletal ultrasound to guide various injections. As a leading imaging technique in Europe, ultrasound is safe, economic, convenient, & effective in diagnosing many injuries. The technology has dramatically improved and allows us to visualize nerve & tendon fibers. While the quality is not quite MRI caliber, ultrasound allows for dynamic (motion studies). In other words, ultrasound allows functional evaluation of an injury with movement, whereas MRI takes a still image. Also, ultrasound has color doppler that shows areas of blood flow changes (called neo vascularization). This allows us to deliver the PRP within a millimeter of the target site, or even discover other regions that are affected.

Ultrasound technology continues to grow. I just upgraded to this Sonosite portable machine with color doppler.

New Platelet Rich Plasma Web Site

I recently launched a web site on PRP. It is another resource for health professionals & patients to learn more about this emerging therapy. Additionally, I will be hosting a conference in early May 2008, in Los Angeles to train other physicians on the use of PRP along with musculoskeletal ultrasound guidance.

www.PRPinjection.com

The site will include testimonials as well as promote further communication amongst patients.

Platelet Rich Plasma Cartilage/Arthritis Study in Rabbits

In a recent study from October 2007, a group from China was the first to document platelet rich plasma's ability to support chondrogenesis (cartilage cell growth). They took cartilage from the rabbit's ear, & mixed it with PRP and calcium chloride & thrombin (to form a matrix). Two months later, hard knobbles were found and seen on MRI, as well as histological analysis (cellular) and staining confirmed cartilage growth. Interestingly, there was no cartilage growth with the control group that received PRP alone. This study demonstrated successful formation of new cartilage with an injectable graft using PRP and cultured chondrocytes.

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

Santa Monica Orthopaedic Group Awarded FIFA Center of Excellence

Our practice was awarded the title of a FIFA Medical Center of Excellence. The Fédération Internationale de Football Association (FIFA) is an association governed by Swiss law founded in 1904 and based in Zurich. They oversee one of the world's largest international sporting events, The World Cup. FIFA hopes to reach out and touch the world, using football(soccer) as a symbol of hope and integration.

Our practice was selected after demonstration of clinical education, research, and injury prevention. Other centers chosen include St Marianna University School of Medicine in Kawasaki, Japan, The Adidas Sports Medicine Centre in Auckland, New Zealand, the Centre for Exercise Science and Sports Medicine at the University of Witwatersrand in Johannesburg, South Africa, and the Orthocentre of the Technical University, Munich.

There will be a ceremony at our facility Monday December 10th, 2007.
These designated centers are open to every soccer player looking for therapy or a second opinion on a specific injury.

http://www.fifa.com/aboutfifa/developing/releases/newsid=653724.html

My Colleagues, Bert Mandelbaum MD & Michael Gerhardt MD are team physicians for the US National Soccer team.

We have used platelet rich plasma on professional soccer athletes to accelerate recovery.

http://prpinjection.blogspot.com/2007/10/cbs-news-with-katie-kouric-prp-feature.html