Showing posts with label knee. Show all posts
Showing posts with label knee. Show all posts

Monday, November 6, 2017

Chicago Bear is treated amongst Platelet Rich Plasma

Chicago Bear Matt Forte has platelet rich injection for knee articulation ligament injury.  


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Exercise Bike Intervals: The Fountain of Youth?

For years now, I accept been preaching to my patients almost why it is of import to ride an utilisation wheel thirty minutes 3 times a calendar week to amend their articulatio genus function.  It does aid strengthen their leg muscles specially the quadriceps, hamstring as well as gluteal muscles if done consistently.  These are patients amongst all types of articulatio genus issues from meniscus tears to advanced articulatio genus osteoarthritis.
See a video of an utilisation wheel program.

Recent inquiry too suggests that brusk intense intervals on a wheel of i infinitesimal amongst a i infinitesimal recovery tin significantly amend cardiovascular fitness as well as too lower blood saccharide inwards patients amongst Type ii Diabetes.  Below is an excerpt from a late published NY Times article almost the subject:


"Several years ago, the McMasters scientists did examination a punishing workout, known every bit high-intensity interval training, or HIIT, that involved thirty seconds of all-out assay at 100 pct of a person’s maximum middle rate. After vi weeks, these lacerating HIIT sessions produced like physiological changesin the leg muscles of immature men every bit multiple, hour-long sessions per calendar week of steady cycling, fifty-fifty though the HIIT workouts involved almost ninety pct less utilisation time.
Recognizing, however, that few of us willingly tin or volition practise such straining all-out effort, the researchers too developed a gentler simply silent chronologically abbreviated assort of HIIT. This modified routine involved i infinitesimal of strenuous effort, at almost ninety pct of a person’s maximum middle charge per unit of measurement (which most of us tin estimate, really roughly, yesteryear subtracting our historic current from 220), followed yesteryear i infinitesimal of slowly recovery. The assay as well as recovery are repeated 10 times, for a amount of twenty minutes."  Read the amount article here.  

I mean value the betoken is clear.  Almost anyone tin laid out amongst i infinitesimal intervals.  The information suggests that if you lot tin construct on that, your middle as well as blood saccharide volition amend inwards add-on to strengthening your knees.  Not a bad proffer for all of us.
AM
Total Tendon

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Friday, November 3, 2017

every mo a potential handling for human knee osteoarthritis


Platelet rich plasma is existence studied worldwide (US, Europe, India) equally a potential handling for knee articulation osteoarthritis.  The prove is young merely it does advise PRP may convey a locomote inwards the management of this rattling mutual problem.

In the report outlined below, PRP was compared to a criterion handling of hyaluronic acid.  

"Statistically significantly ameliorate results inwards the Western Ontario in addition to McMaster Universities Osteoarthritis Index in addition to Numeric Rating Scale scores were recorded inwards a grouping of patients who received PRP injections later a 3- in addition to 6-mo follow-up."


Am J Phys Med Rehabil. 2012 May;91(5):411-7.

Treatment of knee articulation joint osteoarthritis amongst autologous platelet-rich plasma in comparing amongst hyaluronic Acid.

Source

From the Associated Tissue Bank of Faculty of Medicine UPJS in addition to University Hospital of L. Pasteur (TS, JR, DH); in addition to Department of Orthopaedics in addition to Traumatology, Faculty of Medicine, P. J. Safárik University in addition to University Hospital of L. Pasteur, Kosice, Slovakia (ML, AG).

Abstract

OBJECTIVE:

This report aimed to reveal a simple, cost-effective, in addition to time-efficient method for the training of platelet-rich plasma (PRP), then the acquired benefits volition hold out readily available for multiple procedures inwards smaller outpatient clinics in addition to to explore the security in addition to efficacy of the application of PRP inwards the handling of degenerative lesions of articular cartilage of the knee.

DESIGN:

The report was designed equally a prospective, cohort report amongst a command group. H5N1 full of 120 patients amongst Grade 1, 2, or 3 osteoarthritis according to the Kellgren in addition to Lawrence grading scale were enrolled inwards the study. One grouping of patients was treated using 3 intra-articular applications of PRP, in addition to the minute grouping of patients was given 3 injections of hyaluronic acid. Outcome measures included the Western Ontario in addition to McMaster Universities Osteoarthritis Index in addition to the 11-point hurting intensity Numeric Rating Scale.

RESULTS:

On average, a 4.5-fold increase in platelet concentration was obtained inwards the PRP group. No severe adverse events were observed. Statistically significantly ameliorate results inwards the Western Ontario in addition to McMaster Universities Osteoarthritis Index in addition to Numeric Rating Scale scores were recorded inwards a grouping of patients who received PRP injections later a 3- in addition to 6-mo follow-up.

CONCLUSIONS:

Our preliminary findings back upwards the application of autologous PRP equally an effective in addition to rubber method inwards the handling of the initial stages of knee articulation osteoarthritis. Further studies are needed to confirm these results in addition to to investigate the persistence of the beneficial effects 

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The forces supporting your knees are complex only the math is simple

Lose v pounds, your knees volition experience every bit if yous lost 25 pounds.





The forces supporting your knees are complex but the math is simple.  About 4-6 times your trunk weight is transmitted through your articulatio genus articulation when yous but walk.  Think well-nigh that fact for a second.  If yous weigh 200 pounds, your articulatio genus experiences grand pounds of forcefulness piece strolling downwards the street.

Importantly, beingness overweight is a "clear run a jeopardy factor" for articulatio genus osteoarthritis.  For women, beingness overweight increases this run a jeopardy four times higher.  For men, the run a jeopardy increases v crimp inwards patients who are overweight.  Dropping every bit picayune every bit 10 pounds may live on plenty to significantly lower this risk.

There are no uncomplicated solutions to weight loss.  One proffer I laissez passer on my patients is to endeavour the "One Less, One More" plan.  Try it for a week.  One less beer, 1 less drinking glass of wine, 1 less bagel, 1 less serving of H2O ice cream.  One to a greater extent than fourth dimension taking the stairs, 1 to a greater extent than trip to the gym, 1 to a greater extent than walk around the block.

For to a greater extent than information well-nigh articulatio genus osteoarthritis in addition to beingness overweight amongst references for the information outlined about, click here.

Allan Mishra, MD
Send thoughts/ideas well-nigh how to lose weight to:  @bloodcure
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Meta-analysis of Viscosupplementation for Knee Osteoarthritis Reveals Little Benefit


In the study outlined below, handling alongside viscosupplementation (typically diverse forms of hyaluronic acid) was studied inward over 12,500 patients.  This is an injection therapy used inward patients alongside articulatio genus osteoarthritis.  It is commonly reserved for patients that neglect other forms of treatment.  Here is the determination of this study of studies:  "In patients alongside articulatio genus osteoarthritis, viscosupplementation is associated alongside a modest as well as clinically irrelevant create goodness as well as an increased run a jeopardy for serious adverse events."


Clearly, the information shows this handling does non render transformative value.  We withdraw ameliorate options for patients alongside mild to moderate articulatio genus osteoarthritis.  Biologic therapies such every bit platelet rich plasma and autologous stalk cells are evolving only nonetheless withdraw significantly ameliorate studies to endure used for articulatio genus osteoarthritis widely.  

It is oft NOT discussed only patients alongside articulatio genus osteoarthritis tin hand the axe oft create goodness from weight reduction as well as leg strengthening via an practice wheel program.  Perhaps nosotros should focus on these patient driven solutions first.



Viscosupplementation for Osteoarthritis of the KneeA Systematic Review as well as Meta-analysis 

Anne W.S. Rutjes, PhD; Peter Jüni, MD; Bruno R. da Costa, MSc; Sven Trelle, MD; Eveline Nüesch, PhD; as well as Stephan Reichenbach, MD, MScBackground: Viscosupplementation, the intra-articular injection of hyaluronic acid, is widely used for symptomatic articulatio genus osteoarthritis.

Purpose: To assess the benefits as well as risks of viscosupplementation for adults alongside symptomatic articulatio genus osteoarthritis.
Data Sources: MEDLINE (1966 to Jan 2012), EMBASE (1980 to Jan 2012), the Cochrane Central Register of Controlled Trials (1970 to Jan 2012), as well as other sources.
Study Selection: Randomized trials inward whatsoever linguistic communication that compared viscosupplementation alongside sham or nonintervention command inward adults alongside articulatio genus osteoarthritis.
Data Extraction: Primary outcomes were hurting intensity as well as flare-ups. Secondary outcomes included share as well as serious adverse events. Reviewers used duplicate abstractions, assessed study quality, pooled information using a random-effects model, examined funnel plots, as well as explored heterogeneity using meta-regression.
Data Synthesis: Eighty-nine trials involving 12 667 adults met inclusion criteria. Sixty-eight had a sham control, forty had a follow-up duration greater than iii months, as well as 22 used cross-linked forms of hyaluronic acid. Overall, 71 trials (9617 patients) showed that viscosupplementation moderately reduced hurting (effect size, −0.37 [95% CI, −0.46 to −0.28]). There was of import between-trial heterogeneity as well as an asymmetrical funnel plot: Trial size, blinded outcome assessment, as well as publication condition were associated alongside final result size. Five unpublished trials (1149 patients) showed an final result size of −0.03 (CI, −0.14 to 0.09). Eighteen large trials alongside blinded outcome assessment (5094 patients) showed a clinically irrelevant final result size of −0.11 (CI, −0.18 to −0.04). Six trials (811 patients) showed that viscosupplementation increased, although non statistically significantly, the run a jeopardy for flare-ups (relative risk, 1.51 [CI, 0.84 to 2.72]). Fourteen trials (3667 patients) showed that viscosupplementation increased the run a jeopardy for serious adverse events (relative risk, 1.41 [CI, 1.02 to 1.97]).
Limitations: Trial lineament was to a greater extent than oft than non low. Safety information were oft non reported.
Conclusion: In patients alongside articulatio genus osteoarthritis, viscosupplementation is associated alongside a modest as well as clinically irrelevant create goodness as well as an increased run a jeopardy for serious adverse events.


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Shockwave Therapy too Knee Osteoarthritis

Extracorporeal shockwave therapy is the external application of high intensity audio energy.  This type of handling has been applied to kidney stones, fractures, tendonitis together with similar a shot osteoarthritis.   Two preclinical studies published today propose this technique may live on promising.

Two dissimilar models of human knee osteoarthritis were utilized.  One involves cutting the ACL, the other creates a cartilage defect inwards the knee.  Both of these studies propose shockwave therapy may bring value inwards the handling of human knee osteoarthritis.  Appropriate human clinical trials nevertheless remove to live on conducted.


AM

Here are the ii studies:



Clin Orthop Relat Res. 2012 Jun 6. 

Does Extracorporeal Shock Wave Therapy Enhance Healing of Osteochondritis Dissecans of the Rabbit Knee?: H5N1 Pilot Study.



Conclusions
Shockwave therapy "accelerated the healing charge per unit of measurement together with improved cartilage together with subchondral os character inwards the OCD (osteochondritis dissecans) rabbit model.




Journal of Surgical Research

Extracorporeal shockwave therapy shows time-dependent chondroprotective effects inwards osteoarthritis of the human knee inwards rats

  • Ching-Jen Wang, MD
  • , 
  • Yi-Chih Sun, BS
  • , 
  • To Wong, MD
  • , 
  • Shan-Ling Hsu, MD
  • , 
  • Wen-Yi Chou, MD
  • , 
  • Hsueh-Wen Chang, PhD
    • Conclusion

      "Extracorporeal shockwave therapy is effective inwards preventing osteoarthritis of the human knee inwards rats. The beneficial effects of ESWT seem to live on time-dependent showtime at four weeks later on treatment."




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    PRP beats Placebo for Knee Arthritis


    The American Journal of Sports Medicine of late published the results of unopen to other written report supporting the usage of Platelet Rich Plasma for arthritis.  In this really good done study, 2 dissimilar doses of PRP were given to patients too and then compared to a saline injection.  One grouping recieved a unmarried injection of PRP, unopen to other 2 PRP injections spaced three weeks apart too the tertiary grouping a unmarried injection of saline or sterile tabular array salt water.  The tertiary grouping served the placebo control. 

    Statistically pregnant improvements inward hurting too component were noted inward the PRP groups inside 2-3 weeks too lasted vi months.  The saline treated grouping noted worsening of symptoms.  There were no pregnant differences betwixt the 2 PRP groups alongside both showing improvement. 

    Overall, this prospective, randomized trial adds to the mounting evidence that specific forms of PRP tin live helpful for patients alongside human knee osteoarthritis.  See abstract below for details. 

    The usage of PRP for human knee osteoarthritis is apace evolving.  There are at in ane trial 37 articles on PubMed discussing that specific topic.  (Link to abstracts)  Over the class of 2013, to a greater extent than presentations too papers volition assist clarify the role of PRP for this really mutual problem.

    AM
    Total Tendon

    Treatment With Platelet-Rich Plasma Is More Effective Than Placebo for Knee Osteoarthritis: Influenza A virus subtype H5N1 Prospective, Double-Blind, Randomized Trial.

    Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A.
    Am J Sports Med. 2013 January 8. [Epub ahead of print]
    SourceDepartment of Orthopaedics, Post Graduate Institute of Medical Education too Research, Chandigarh, India.

    BACKGROUND:Specific increment factors accept been proposed equally therapeutic proteins for cartilage repair. HYPOTHESIS:Platelet-rich plasma (PRP) provides symptomatic relief inward early on osteoarthritis (OA) of the knee. STUDY DESIGN:Randomized controlled trial; Level of evidence, 1. METHODS:A full of 78 patients (156 knees) alongside bilateral OA were divided randomly into three groups. Group Influenza A virus subtype H5N1 (52 knees) received a unmarried injection of PRP, grouping B (50 knees) received 2 injections of PRP three weeks apart, too grouping C (46 knees) received a unmarried injection of normal saline. White blood jail cellular telephone (WBC)-filtered PRP alongside a platelet count three times that of baseline (PRP type 4B) was administered inward all. All the groups were homogeneous too comparable inward baseline characteristics. Clinical outcome was evaluated using the Western Ontario too McMaster Universities Arthritis Index (WOMAC) questionnaire earlier handling too at vi weeks, three months, too vi months after treatment. They were too evaluated for hurting past times a visual analog scale, too overall satisfaction alongside the physical care for too complications were noted. RESULTS:Statistically pregnant improvement inward all WOMAC parameters was noted inward groups Influenza A virus subtype H5N1 too B inside 2 to three weeks too lasting until the concluding follow-up at vi months, alongside slight worsening at the 6-month follow-up. The hateful WOMAC scores (pain, stiffness, physical function, too full score) for grouping Influenza A virus subtype H5N1 at baseline were 10.18, 3.12, 36.56, too 49.86, respectively, too at concluding follow-up were 5.00, 2.10, 20.08, too 27.18, respectively, showing pregnant improvement. Similar improvement was noted inward grouping B (mean WOMAC scores at baseline: 10.62, 3.50, 39.10, too 53.20, respectively; hateful WOMAC scores at concluding follow-up: 6.18, 1.88, 22.40, too 30.48, respectively). In grouping C, the hateful WOMAC scores deteriorated from baseline (9.04, 2.70, 33.80, too 45.54, respectively) to concluding follow-up (10.87, 2.76, 39.46, too 53.09, respectively). The three groups were compared alongside each other, too no improvement was noted inward grouping C equally compared alongside groups Influenza A virus subtype H5N1 too B (P < .001). There was no divergence betwixt groups Influenza A virus subtype H5N1 too B, too at that spot was no influence of age, sex, weight, or torso volume index on the outcome. Knees alongside Ahlback degree 1 fared improve than those alongside degree 2. Mild complications such equally nausea too dizziness, which were of brusk duration, were observed inward vi patients (22.2%) inward grouping Influenza A virus subtype H5N1 too eleven patients (44%) inward grouping B. CONCLUSION:A unmarried dose of WBC-filtered PRP inward concentrations of 10 times the normal total is equally effective equally 2 injections to alleviate symptoms inward early on human knee OA. The results, however, deteriorate after vi months. Both groups treated alongside PRP had improve results than did the grouping injected alongside saline only.




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    Platelet-rich Plasma Update from Toronto, ISAKOS 2013


    The International Society of Arthroscopy, Knee Surgery in addition to Orthopaedic Sports Medicine (ISAKOS) is a gathering of several K professionals that is shortly taking house inward Toronto, Canada.  Today, a platelet-rich plasma (PRP), Instructional Course Lecture was offered to over 100 participants.  Lectures close how to purpose or non purpose PRP were given past times MD Rogerio Silva, MD Allan Mishra, MD Nicola Maffuli in addition to MD Steven Arnoczky.  At to the lowest degree 10 other PRP lectures were given at the conference including MD Mandeep Dhillion from Republic of Republic of India presenting his fantabulous report showing the value of PRP for articulatio genus osteoarthritis.  Basic scientific discipline papers past times MD Joon Lee et al from Korea besides showed a chondro-protective upshot of PRP subsequently astute ACL tears.  It is becoming increasingly hard to proceed upward alongside the dramatic rising inward PRP related presentations in addition to papers.  Overall, it is clear that in that place is increasing worldwide involvement inward this point-of-care, blood-derived bioactive treatment.  As the information matures nosotros volition amend sympathise how to purpose PRP to help aid for patients.  Presently, in that place is fantabulous marker 1 back upward for its purpose inward chronic lawn tennis elbow.

    AM


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    Platelet Rich Plasma Significantly Improves Outcomes for Tennis Elbow inward a 230 Patient Study


    The American Journal of Sports Medicine (AJSM) has merely published the largest study evaluating platelet-rich plasma.  The 230 patient study was conducted over the course of education of to a greater extent than than 5 years together with represents the locomote of dozens of clinicians together with researchers.  Overall, it is clear from the information that the purpose of PRP to process chronic lawn tennis elbow results inward important reductions inward hurting together with elbow tenderness compared to an active command of needling of the elbow without PRP.  It is every bit good security together with toll effective compared to cortisone together with surgery.  This type of study is fourth dimension consuming together with expensive but volition assistance guide patient together with physicians decisions nearly how to best process chronic lawn tennis elbow.

    Here is a lay press article on the article from Healio.

    Read the total AJSM Abstract below.

    AM
    Total Tendon


    Platelet-Rich Plasma Significantly Improves Clinical Outcomes inward Patients With Chronic Tennis Elbow
    A Double-Blind, Prospective, Multicenter, Controlled Trial of 230 Patients
    1. Arthur C. Rettig, MD‡‡

    1. Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, California
    2. Tucson Orthopaedic Institute, Tucson, Arizona
    3. §Division of Hand together with Elbow Surgery, Georgetown University Hospital, Washington, District of Columbia
    4. Department of Orthopaedic Surgery, The Ohio State University, Columbus, Ohio
    5. The Orthohealing Center together with The Orthobiologic Institute, Los Angeles, California
    6. #Orthopaedic Research Clinic, Anchorage, Alaska
    7. **Department of Orthopaedic Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania
    8. ††The Steadman Clinic, Vail, Colorado
    9. ‡‡Methodist Sports Medicine, Indianapolis, Indiana
    10. Investigation performed at Department of Orthopaedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, Menlo Park, California
    1. *Allan K. Mishra, MD, Department of Orthopedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, 1300 Crane Street, Menlo Park, CA 94025 (e-mail: am@totaltendon.com).

    Abstract

    Background: Elbow tenderness together with hurting amongst resisted wrist extension are mutual manifestations of lateral epicondylar tendinopathy, every bit good known every bit lawn tennis elbow. Previous studies bring suggested platelet-rich plasma (PRP) to live a security together with effective therapy for lawn tennis elbow.
    Purpose: To evaluate the clinical value of tendon needling amongst PRP inward patients amongst chronic lawn tennis elbow compared amongst an active command group.
    Study Design: Randomized controlled trial; Level of evidence, 1.
    Methods: A total of 230 patients amongst chronic lateral epicondylar tendinopathy were treated at 12 centers over 5 years. All patients had at to the lowest degree three months of symptoms together with had failed conventional therapy. There were no differences inward patients randomized to have PRP (n = 116) or active controls (n = 114). The PRP was prepared from venous whole blood at the quest of attention together with contained both concentrated platelets together with leukocytes. After receiving a local anesthetic, all patients had their extensor tendons needled amongst or without PRP. Patients together with investigators remained blinded to the handling grouping throughout the study.
    Results: Patient outcomes were followed for upwards to 24 weeks. At 12 weeks (n = 192), the PRP-treated patients reported an improvement of 55.1% inward their hurting scores compared amongst 47.4% inward the active command grouping (P = .094). At 24 weeks (n = 119), the PRP-treated patients reported an improvement of 71.5% inward their hurting scores compared amongst 56.1% inward the command grouping (P = .027). The percent of patients reporting important elbow tenderness at 12 weeks was 37.4% inward the PRP grouping versus 48.4% inward the command grouping (P = .036). At 24 weeks, 29.1% of the PRP-treated patients reported important elbow tenderness versus 54.0% inward the command grouping (P < .001). Success rates for patients amongst 24 weeks of follow-up were 83.9% inward the PRP grouping compared amongst 68.3% inward the command grouping (P= .012). No important complications occurred inward either group.
    Conclusion: Treatment of chronic lawn tennis elbow amongst leukocyte-enriched PRP is security together with results inward clinically meaningful improvements compared amongst an active command group.

    The Biomet Biologics GPS device was used to produce the PRP for this study.

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