OUR SERVICES

OSTEOARTHRITIS

   PRP (Platelet Rich Plasma) is an advanced treatment method that offers multiple benefits when injected into joints. It serves as an anti-inflammatory agent and analgesic, leading to improved joint function, reduced pain, and enhanced quality of life for patients. One of the key factors responsible for these positive effects is IGF-1 (Insulin-like Growth Factor-1), which is released by platelets upon activation. IGF-1 has the ability to inhibit the cascade of apoptosis (cell death), which is a primary target in the treatment of osteoarthritis. By slowing down the progression of degenerating chondrocytes (cartilage cells) towards apoptosis, PRP effectively decelerates the overall disease progression (Zubair, 2018).

   When it comes to non-pharmacological treatments for symptomatic knee osteoarthritis, the current approach involves a combination of patient education, self-management of risk factors, exercise, weight loss, physical therapy, and the use of orthotics. Pharmacological options include topical anti-inflammatory drugs (NSAIDs), oral supplements like glucosamine and chondroitin sulphate, and various injection therapies (Znag, 2008; Wang, 2016).

   Among the injection therapies available, four main options are commonly utilized: corticosteroids, viscosupplementation with Hyaluronic Acid (HA), Platelet Rich Plasma (PRP), and autologous mesenchymal stem cells (MSCs) (Levy, 2018).

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Platelet-rich plasma (PRP) and hyaluronic acid (HA) are used in the treatment of osteoarthritis (OA) to improve pain and function.

PRP is derived from the patient's own blood and contains a high concentration of platelets, which release growth factors that can promote tissue repair and reduce inflammation. HA is a naturally occurring substance in the synovial fluid of joints, providing lubrication and shock absorption.

Combination Therapy:

Several studies have shown that the combination of PRP and HA is more effective than either treatment alone. Xu et al. demonstrated that intra-articular injections of PRP combined with HA significantly improved pain and function in patients with knee OA compared to PRP or HA alone.[1] This combination therapy was superior in inhibiting inflammation and improving synovial and cartilage health.

Efficacy:

A systematic review by Baria et al. found that combination therapy with PRP and HA improved patient-reported outcomes (PROs) and was superior to HA alone but not to PRP alone.[2] Another meta-analysis by Karasavvidis et al. confirmed that PRP combined with HA resulted in greater improvements in pain and function compared to HA alone.[3]

Mechanism:

The synergistic effect of PRP and HA is attributed to the combined anti-inflammatory and regenerative properties. PRP promotes cartilage regeneration and reduces inflammatory cytokines, while HA provides viscoelastic support and further reduces inflammation.[4-5]

The combination of PRP and HA is a promising treatment for OA, offering superior outcomes in pain relief and functional improvement compared to HA alone. However, it is not consistently superior to PRP alone. Further research is needed to optimize treatment protocols and understand the long-term benefits.

   Based on my experience, I have found that the injection of PRP alone or in combination with HA yields the most favorable outcomes for patients. This approach leads to effective pain reduction and facilitates a longer duration of activity and functionality, with a reduced risk of complications. By combining the regenerative properties of PRP with the supportive benefits of HA, patients experience significant relief and improved overall outcomes

Tendinopathies and Treatment Approaches

Tendinopathies are common conditions that can cause significant pain and disability. They affect various tendons in the body, including those in the lower limbs, shoulders, and elbows. Studies indicate that tendinopathies are prevalent among both athletes and the general population, with an increased incidence in individuals over 50 years old (Albers, 2014; Segal, 2007).

When it comes to treating chronic recalcitrant tendinopathies with moderate to severe tendinosis and/or partial tendon tears, ultrasound-guided intra-tendinous PRP injections have been shown to be a safe and effective treatment option (Lee, 2016). This approach delivers platelet-rich plasma directly to the affected tendon, promoting healing, reducing inflammation, and alleviating pain.

It is important to note that many practitioners may initially misdiagnose tendinopathy as bursitis, often opting for steroid injections. However, tendinopathies frequently represent the primary source of pain, and while steroid injections may offer temporary relief, they can also contribute to tendon atrophy and weakening over time (Kraeutler et al., 2016).

In summary, ultrasound-guided intra-tendinous PRP injections are a recommended treatment for chronic tendinopathies. This method has demonstrated both safety and effectiveness in providing long-term pain relief and promoting tendon repair for individuals with moderate to severe tendinosis and/or partial tendon tears. It is crucial to differentiate tendinopathy from bursitis to ensure the most appropriate and targeted treatment, while also avoiding potential complications associated with steroid injections.

MENISCAL TEARS

   Meniscal tears are a prevalent orthopedic condition and have been the focus of numerous treatment approaches. Arthroscopy has long been considered the "gold standard" therapy, with millions of procedures performed worldwide annually for meniscus pathologies (Hawker, 2008). It is noteworthy that more than 50% of these surgeries are conducted in patients older than 45 years with degenerative meniscal lesions (Englund, 2008).

   One of the major challenges faced by orthopedic surgeons is achieving meniscal healing. Various types of meniscectomies can increase the risk of developing osteoarthritis (Delos, 2011). Evidence comparing the outcomes of total and partial meniscectomy highlights the beneficial effects of meniscus preservation (Paxton, 2011).

   In recent years, the use of Platelet Rich Plasma (PRP) has emerged as a promising approach for enhancing meniscal healing. When PRP is used as an augmentation therapy for meniscal tears, it leads to a significant improvement in the rate of meniscal healing. Notably, this simple procedure has the potential to reduce the need for future arthroscopy (8% vs. 28%, P = 0.032). Studies have consistently shown that PRP augmentation can provide substantial and clinically important benefits in promoting meniscal healing. Furthermore, the risk of adverse events associated with percutaneous trephination and PRP augmentation is very low (Kaminski, 2019).

   In summary, meniscal tears pose a significant challenge in orthopedics, and meniscus preservation is crucial to prevent the development of osteoarthritis. The use of PRP as an augmentation therapy has shown promising results in improving the rate of meniscal healing. This simple procedure not only enhances outcomes but also reduces the future need for arthroscopy. Moreover, the risk of adverse events associated with percutaneous trephination and PRP augmentation is minimal. These findings support the integration of PRP as a valuable adjunctive treatment for meniscal tears.