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1.
Mil Med ; 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33770175

RESUMO

INTRODUCTION: Extracorporeal shockwave therapy (ESWT) has a wide variety of clinical applications ranging from urology to orthopedics. Extracorporeal shockwave therapy is of particular interest to military medicine in the treatment of diverse musculoskeletal injuries, including recalcitrant tendinopathy. Much of the evidence for ESWT is from studies in the civilian population, including athletes. A few investigations have been conducted within military personnel. Musculoskeletal conditions within military personnel may contribute to pain and physical limitations. Optimal functional outcomes could be achieved through ESWT. The purpose of this narrative review is to summarize the current evidence on the efficacy of ESWT the in management of lower extremity musculoskeletal injuries in the military. Further, we explore the relative efficacy of ESWT compared to regenerative medicine procedures, including studies with treatment using platelet-rich plasma. MATERIALS AND METHODS: A literature review was performed in April 2020 to identify studies evaluating the use of ESWT for lower extremity conditions commonly observed in military personnel, including plantar fasciitis, Achilles tendinopathy, patellar tendinopathy, medial tibial stress syndrome, and knee arthritis. The literature search was completed by two researchers independently, using PubMed and Embase databases and same search terms. Disagreements were adjudicated by a senior author. Due to the paucity of relevant search results, the search term parameters were expanded to incorporate active participants. RESULTS: Two studies evaluated the use of ESWT in a military population for lower extremity injuries. This included a randomized control trial in active military with medial tibial stress syndrome and an unblinded retrospective study for the chronic plantar fasciitis condition. Both studies in the military had favorable outcomes in the use of ESWT compared to other treatment arms. The remaining studies predominantly included athletes. Although heterogeneity on the quality of the studies may prevent meta-analysis and limit the generalization of the findings, the majority of studies demonstrated an improvement in pain and return to activity using ESWT. Two studies using platelet-rich plasma as a treatment arm identified similar short-term outcomes compared to ESWT for Achilles tendinopathy and patellar tendinopathy. CONCLUSION: Our findings suggest that ESWT is a safe and well-tolerated intervention with positive outcomes for lower extremity conditions commonly seen in the military. The few studies comparing ESWT to PRP suggest regenerative benefits similar to orthobiologics in the shorter term. More robust quality designed research may enable the evaluation of ESWT efficacy within the military population. In summary, the use of ESWT may provide pain reduction and improved function in active populations with lower extremity musculoskeletal injuries. Further research in the military is needed to evaluate shockwave efficacy in order to advance musculoskeletal care and improve outcomes.

2.
Pain Physician ; 24(S1): S233-S246, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33492920

RESUMO

BACKGROUND: Corticosteroids have been used for the past 70 years in the treatment of various musculoskeletal conditions. This includes its use for joint pain such as rheumatoid arthritis and osteoarthritis. OBJECTIVES: A narrative review of the literature from its initial discovery to the present day to summarize the research of corticosteroids for joint pain to determine the safety and effectiveness of this commonly used and prescribed medication. METHODS: A review of the literature was performed regarding the effectiveness and side effects of corticosteroids for joint and osteoarthritis conditions. RESULTS: The current evidence would suggest that the use of corticosteroids provides moderate short-term benefit for reducing pain and improving functioning. These benefits generally last several weeks without long-term effectiveness. In addition to its limited short-term effectiveness, there are multiple potential adverse effects including toxicity to articular cartilage and numerous systemic side effects such as increases in blood glucose levels, a reduction in immune function, and an increased risk of infections. LIMITATIONS: English only articles were reviewed. No attempt was made to perform a formal statistical or meta-analysis. CONCLUSIONS: The current evidence would suggest that the use of corticosteroids provides moderate evidence for short-term pain reduction and improvement in function. There are multiple potential adverse effects, such as toxic damage to articular cartilage, as well as numerous systemic side effects, including a reduction in immune function and an increased risk of infection, of which physicians need to be aware.

3.
Int J Mol Sci ; 22(2)2021 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-33467646

RESUMO

Achilles tendon ruptures are very common tendon ruptures and their incidence is increasing in modern society, resulting in work incapacity and months off sport, which generate a need for accelerated and successful therapeutic repair strategy. Platelet-rich plasma (PRP) is emerging as adjuvant human blood-derived constructs to assist Achilles tendon rupture treatment. However, myriad PRP preparation methods in conjunction with poor standardization in the modalities of their applications impinge on the consistent effectiveness of clinical and structural outcomes regarding their therapeutic efficacy. The purpose of this review is to provide some light on the application of PRP for Achilles tendon ruptures. PRP has many characteristics that make it an attractive treatment. Elements such as the inclusion of leukocytes and erythrocytes within PRP, the absence of activation and activation ex vivo or in vivo, the modality of application, and the adjustment of PRP pH can influence the biology of the applied product and result in misleading therapeutic conclusions. The weakest points in demonstrating their consistent effectiveness are primarily the result of myriad PRP preparation methods and the poor standardization of modalities for their application. Selecting the right biological scaffold and applying it correctly to restitutio ad integrum of ruptured Achilles tendons remains a daunting and complex task.


Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Colágeno/química , Queratinócitos/citologia , Plasma Rico em Plaquetas/metabolismo , Ruptura/cirurgia , Traumatismos dos Tendões/cirurgia , Ciclo Celular , Movimento Celular , Proliferação de Células , Receptores ErbB/metabolismo , Humanos , Integrina beta1/metabolismo , Queratinócitos/metabolismo , Ligantes , NF-kappa B/metabolismo , Receptor IGF Tipo 1/metabolismo , Transdução de Sinais , Cicatrização
5.
Int Orthop ; 2020 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-33026537

RESUMO

PURPOSE: The management of knee pain secondary to meniscal tears with osteoarthritis is limited by the poor inherent healing potential of the meniscus. Previous studies have reported on the benefit of autologous micro-fragmented fat as a therapeutic for various knee pathologies. The goal of this prospective pilot study was to determine the safety and potential treatment effect of micro-fragmented adipose tissue injection for patients with knee pain secondary to osteoarthritis and meniscal tears who have failed conservative management. METHODS: Twenty subjects with knee pain secondary to osteoarthritis with associated meniscal tear after failed conservative management were enrolled in the study. Numeric Pain Scale (NPS) and Knee Injury and Osteoarthritis Outcome Scale (KOOS) following ultrasound-guided intra-meniscal and intra-articular micro-fragmented adipose tissue injections were examined at three, six and 12 months. RESULTS: The mean NPS revealed a significant decrease in patient pain at the 1-year time point compared with baseline (5.45 to 2.21, p < .001). Similarly, overall, mean KOOS symptoms significantly improved from 57.7 to 78.2 (p < .001), with all 4 KOOS subscales demonstrating significant improvement at the final one year follow-up. One subject developed uncomplicated cellulitis at the harvest site which was treated with oral antibiotics. Other complications were minor and mostly limited to adipose harvest. CONCLUSION: This study demonstrated that micro-fragmented adipose tissue injected directly into a torn meniscus and knee joint using ultrasound guidance represents a safe and potentially efficacious treatment option for patients with knee pain suffering from degenerative arthritis and degenerative meniscal tears. A larger, randomized, controlled trial is warranted to determine efficacy. TRIAL REGISTRATION: Clinicaltrials.org Identifier: NCT03714659.

6.
Expert Opin Biol Ther ; : 1-14, 2020 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-32692595

RESUMO

INTRODUCTION: Platelet-rich plasma (PRP) is able to modulate the joint environment by reducing the inflammatory distress and promoting tissue anabolism. Therefore, it has gained increasing popularity among clinicians in the treatment of osteoarthritis (OA), and it is currently proposed beside consolidated options such as viscosupplementation. AREAS COVERED: A systematic review of all available meta-analyses evaluating intra-articular PRP injections in patients affected by knee OA was performed, to understand how this biologic treatment approach compares to the traditional injective therapies available in clinical practice. Moreover, a novel coding system and 'minimum reporting requirements' are proposed to improve future research in this field and promote a better understanding of the mechanisms of action and indications. EXPERT OPINION: The main limitation in the current literature is the extreme variability of PRP products used, with often paucity or even lack of data on the biologic features of PRP, which should not be considered as a simple substance, but rather a 'procedure' requiring accurate reporting of the characteristics of the product but also all preparation and application modalities. This approach will aid in matching the optimal PRP product to specific patient factors, leading to improved outcomes and the elucidation of the cost-effectiveness of this treatment.

7.
Cartilage ; : 1947603520942937, 2020 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-32698601

RESUMO

The knee joint is one of the most frequently injured joints in the body, and the resulting injury may often lead to the presence of a bloody effusion, or hemarthrosis. The acute management of this condition can have long-lasting implications, and may ultimately result in the early onset of osteoarthritis in this population. Heme, a breakdown product of erythrocytes, and associated pro-inflammatory mediators, are known to have deleterious interactions with cartilage and synovium. The presence of blood in a joint following injury can precipitate these effects and accelerate the degenerative changes in the joint. Currently, there is no consensus on the optimal management of a traumatic knee joint injury with a hemarthrosis. Nontraumatic hemarthosis, seen most commonly in hemophilia patients, has a set of established guidelines that does not routinely recommend drainage of the joint. This article presents a rationale for joint aspiration to minimize the harmful effects of blood following traumatic hemarthrosis.

8.
J Spinal Cord Med ; : 1-7, 2020 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-32379581

RESUMO

Context/Objective: Wheelchair users with spinal cord injury (SCI) have a high risk of developing shoulder pain, caused by rotator cuff disease. Platelet-rich plasma (PRP) is a potential treatment after conservative treatments fail and prior to surgical intervention; however, it has not been tested in wheelchair users who have recalcitrant shoulder pain associated with rotator cuff disease. The objective of this pilot project was to test the safety and potential treatment effect of an ultrasound-guided PRP injection for shoulder pain in the aforementioned population.Design: Prospective, quasi-experimental.Setting: Clinical research center.Participants: Six wheelchair users with SCI (3 paraplegia, 3 tetraplegia) who had chronic shoulder pain due to rotator cuff disease (presence of anterior shoulder pain, positive physical examination tests for rotator cuff disease, and tendinopathy demonstrated by ultrasound) and failed at least six months of conservative treatment.Interventions: Ultrasound-guided PRP injection into pathological shoulder tendons, targeting the supraspinatus. Subjects were provided a standardized stretching and strengthening program and were followed for 4, 8, 12, and 24 weeks post-intervention with outcomes collected at each time-point.Outcome Measures: Wheelchair User's Shoulder Pain Index (WUSPI); pain Numerical Rating Scale (NRS); physical and ultrasound examinations for supraspinatus tendinopathy; 5-point patient global impression of change (PGIC).Results: WUSPI (69.9%, P < 0.001), NRS (49.6%, P < 0.01), and physical exam scores (35.7%, P < 0.01) decreased 24 weeks after treatment. Participants reported overall improvement in their status as a result of the treatment. No adverse events were noted, and no changes in ultrasound markers for tendinopathy were observed.Conclusion: A single, ultrasound-guided PRP injection into the supraspinatus tendon, followed by a stretching and strengthening exercise program, was safe and provided improvements in shoulder pain outcome measures in this sample for 24 weeks. Lack of blinding, short-term follow-up, and a suitable control group warrant a larger randomized controlled trial.Trial Registration: NCT01355549.

9.
Pain Physician ; 23(2): E85-E131, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32214287

RESUMO

BACKGROUND: The use of bone marrow concentrate (BMC) for treatment of musculoskeletal disorders has become increasingly popular over the last several years, as technology has improved along with the need for better solutions for these pathologies. The use of cellular tissue raises a number of issues regarding the US Food and Drug Administration's (FDA) regulation in classifying these treatments as a drug versus just autologous tissue transplantation. In the case of BMC in musculoskeletal and spine care, this determination will likely hinge on whether BMC is homologous to the musculoskeletal system and spine. OBJECTIVES: The aim of this review is to describe the current regulatory guidelines set in place by the FDA, specifically the terminology around "minimal manipulation" and "homologous use" within Regulation 21 CFR Part 1271, and specifically how this applies to the use of BMC in interventional musculoskeletal medicine. METHODS: The methodology utilized here is similar to the methodology utilized in preparation of multiple guidelines employing the experience of a panel of experts from various medical specialties and subspecialties from differing regions of the world. The collaborators who developed these position statements have submitted their appropriate disclosures of conflicts of interest. Trustworthy standards were employed in the creation of these position statements. The literature pertaining to BMC, its effectiveness, adverse consequences, FDA regulations, criteria for meeting the standards of minimal manipulation, and homologous use were comprehensively reviewed using a best evidence synthesis of the available and relevant literature. RESULTS/Summary of Evidence: In conjunction with evidence-based medicine principles, the following position statements were developed: Statement 1: Based on a review of the literature in discussing the preparation of BMC using accepted methodologies, there is strong evidence of minimal manipulation in its preparation, and moderate evidence for homologous utility for various musculoskeletal and spinal conditions qualifies for the same surgical exemption. Statement 2: Assessment of clinical effectiveness based on extensive literature shows emerging evidence for multiple musculoskeletal and spinal conditions. • The evidence is highest for knee osteoarthritis with level II evidence based on relevant systematic reviews, randomized controlled trials and nonrandomized studies. There is level III evidence for knee cartilage conditions. • Based on the relevant systematic reviews, randomized trials, and nonrandomized studies, the evidence for disc injections is level III. • Based on the available literature without appropriate systematic reviews or randomized controlled trials, the evidence for all other conditions is level IV or limited for BMC injections. Statement 3: Based on an extensive review of the literature, there is strong evidence for the safety of BMC when performed by trained physicians with the appropriate precautions under image guidance utilizing a sterile technique. Statement 4: Musculoskeletal disorders and spinal disorders with related disability for economic and human toll, despite advancements with a wide array of treatment modalities. Statement 5: The 21st Century Cures Act was enacted in December 2016 with provisions to accelerate the development and translation of promising new therapies into clinical evaluation and use. Statement 6: Development of cell-based therapies is rapidly proliferating in a number of disease areas, including musculoskeletal disorders and spine. With mixed results, these therapies are greatly outpacing the evidence. The reckless publicity with unsubstantiated claims of beneficial outcomes having putative potential, and has led the FDA Federal Trade Commission (FTC) to issue multiple warnings. Thus the US FDA is considering the appropriateness of using various therapies, including BMC, for homologous use. Statement 7: Since the 1980's and the description of mesenchymal stem cells by Caplan et al, (now called medicinal signaling cells), the use of BMC in musculoskeletal and spinal disorders has been increasing in the management of pain and promoting tissue healing. Statement 8: The Public Health Service Act (PHSA) of the FDA requires minimal manipulation under same surgical procedure exemption. Homologous use of BMC in musculoskeletal and spinal disorders is provided by preclinical and clinical evidence. Statement 9: If the FDA does not accept BMC as homologous, then it will require an Investigational New Drug (IND) classification with FDA (351) cellular drug approval for use. Statement 10: This literature review and these position statements establish compliance with the FDA's intent and corroborates its present description of BMC as homologous with same surgical exemption, and exempt from IND, for use of BMC for treatment of musculoskeletal tissues, such as cartilage, bones, ligaments, muscles, tendons, and spinal discs. CONCLUSIONS: Based on the review of all available and pertinent literature, multiple position statements have been developed showing that BMC in musculoskeletal disorders meets the criteria of minimal manipulation and homologous use. KEY WORDS: Cell-based therapies, bone marrow concentrate, mesenchymal stem cells, medicinal signaling cells, Food and Drug Administration, human cells, tissues, and cellular tissue-based products, Public Health Service Act (PHSA), minimal manipulation, homologous use, same surgical procedure exemption.


Assuntos
Transplante de Medula Óssea/normas , Medicina Baseada em Evidências/normas , Doenças Musculoesqueléticas/terapia , Manejo da Dor/normas , Médicos/normas , Sociedades Médicas/normas , Medula Óssea/fisiologia , Transplante de Medula Óssea/métodos , Medicina Baseada em Evidências/métodos , Humanos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Dor/diagnóstico , Dor/epidemiologia , Manejo da Dor/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Resultado do Tratamento , Estados Unidos , United States Food and Drug Administration/normas
10.
Arch Phys Med Rehabil ; 101(5): 917-923, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32035141

RESUMO

The growing field of regenerative rehabilitation has great potential to improve clinical outcomes for individuals with disabilities. However, the science to elucidate the specific biological underpinnings of regenerative rehabilitation-based approaches is still in its infancy and critical questions regarding clinical translation and implementation still exist. In a recent roundtable discussion from International Consortium for Regenerative Rehabilitation stakeholders, key challenges to progress in the field were identified. The goal of this article is to summarize those discussions and to initiate a broader discussion among clinicians and scientists across the fields of regenerative medicine and rehabilitation science to ultimately progress regenerative rehabilitation from an emerging field to an established interdisciplinary one. Strategies and case studies from consortium institutions-including interdisciplinary research centers, formalized courses, degree programs, international symposia, and collaborative grants-are presented. We propose that these strategic directions have the potential to engage and train clinical practitioners and basic scientists, transform clinical practice, and, ultimately, optimize patient outcomes.


Assuntos
Medicina Regenerativa/tendências , Reabilitação/tendências , Certificação , Congressos como Assunto , Currículo , Bolsas de Estudo , Humanos , Medicina Regenerativa/educação , Reabilitação/educação
12.
Artigo em Inglês | MEDLINE | ID: mdl-31632705

RESUMO

Introduction: Shoulder pain is common in persons with chronic spinal cord injury (SCI), with a prevalence reported as high as 70%. Current treatment of shoulder pain includes conservative measures such as physical therapy, pain medications, patient education, injections, and assistive devices. When conservative treatments fail, shoulder surgery is often the next option. Unfortunately, outcomes after shoulder surgery in persons with SCI are limited and conflicting. Case presentation: This is a case of a 54-year-old right-handed male with T10 complete SCI (duration of injury = 10 years) who had a complaint of right-sided shoulder pain for 3 years. The individual used a manual wheelchair as his primary means of mobility and was an avid weight-lifter. Physical examination and MRI demonstrated a rotator cuff tear and degenerative changes of the acromioclavicular joint. He was previously managed conservatively with physical therapy and intermittent corticosteroid injections but failed to improve. He was enrolled in an IRB approved study and underwent an ultrasound-guided injection with autologous, micro-fragmented adipose tissue (MFAT) and ultimately received improvements in pain and function that were maintained a year after treatment. Discussion: To our knowledge, this is the first reported case of treatment of chronic refractory shoulder pain in a person with SCI using MFAT. Complete relief from pain was maintained at the 1-year follow-up. Injection of MFAT under ultrasound guidance is an effective and promising treatment for chronic refractory shoulder pain in upper limb-dependent persons with SCI and warrants further research.


Assuntos
Tecido Adiposo/transplante , Lesões do Manguito Rotador/terapia , Dor de Ombro/terapia , Traumatismos da Medula Espinal , Dor Crônica/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/diagnóstico , Dor de Ombro/diagnóstico , Dor de Ombro/etiologia , Transplante Autólogo , Cadeiras de Rodas
13.
Regen Ther ; 11: 56-64, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31193111

RESUMO

Autologous biologics, defined as platelet-rich plasma (PRP) and bone marrow aspirate concentrate (BMC), are cell-based therapy treatment options in regenerative medicine practices, and have been increasingly used in orthopedics, sports medicine, and spinal disorders. These biological products are produced at point-of-care; thereby, avoiding expensive and cumbersome culturing and expansion techniques. Numerous commercial PRP and BMC systems are available but reports and knowledge of bio-cellular formulations produced by these systems are limited. This limited information hinders evaluating clinical and research outcomes and thus making conclusions about their biological effectiveness. Some of their important cellular and protein properties have not been characterized, which is critical for understanding the mechanisms of actions involved in tissue regenerative processes. The presence and role of red blood cells (RBCs) in any biologic has not been addressed extensively. Furthermore, some of the pathophysiological effects and phenomena related to RBCs have not been studied. A lack of a complete understanding of all of the biological components and their functional consequences hampers the development of clinical standards for any biological preparation. This paper aims to review the clinical implications and pathophysiological effects of RBCs in PRP and BMC; emphasizes hemolysis, eryptosis, and the release of macrophage inhibitory factor; and explains several effects on the microenvironment, such as inflammation, oxidative stress, vasoconstriction, and impaired cell metabolism.

15.
Spinal Cord Ser Cases ; 5(1): 46, 2019 05 13.
Artigo em Inglês | MEDLINE | ID: mdl-32393763

RESUMO

INTRODUCTION: Shoulder pain is common in persons with chronic spinal cord injury (SCI), with a prevalence reported as high as 70%. Current treatment of shoulder pain includes conservative measures such as physical therapy, pain medications, patient education, injections, and assistive devices. When conservative treatments fail, shoulder surgery is often the next option. Unfortunately, outcomes after shoulder surgery in persons with SCI are limited and conflicting. CASE PRESENTATION: This is a case of a 54-year-old right-handed male with T10 complete SCI (duration of injury = 10 years) who had a complaint of right-sided shoulder pain for 3 years. The individual used a manual wheelchair as his primary means of mobility and was an avid weight-lifter. Physical examination and MRI demonstrated a rotator cuff tear and degenerative changes of the acromioclavicular joint. He was previously managed conservatively with physical therapy and intermittent corticosteroid injections but failed to improve. He was enrolled in an IRB approved study and underwent an ultrasound-guided injection with autologous, micro-fragmented adipose tissue (MFAT) and ultimately received improvements in pain and function that were maintained a year after treatment. DISCUSSION: To our knowledge, this is the first reported case of treatment of chronic refractory shoulder pain in a person with SCI using MFAT. Complete relief from pain was maintained at the 1-year follow-up. Injection of MFAT under ultrasound guidance is an effective and promising treatment for chronic refractory shoulder pain in upper limb-dependent persons with SCI and warrants further research.


Assuntos
Tecido Adiposo/transplante , Dor Crônica/terapia , Lesões do Manguito Rotador/complicações , Dor de Ombro/terapia , Traumatismos da Medula Espinal/complicações , Autoenxertos , Dor Crônica/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor de Ombro/etiologia , Resultado do Tratamento , Cadeiras de Rodas
16.
PM R ; 11(3): 292-308, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30195704

RESUMO

The meniscal tear treatment paradigm traditionally begins with conservative measures such as physical therapy and referral for operative management for persistent or mechanical symptoms. As a result, the partial meniscectomy is performed more than any other orthopedic procedure in the United States. This treatment paradigm has shifted because recent literature has supported the attempt to preserve or repair the meniscus whenever possible given its importance for the structural integrity of the knee joint and the risk of early osteoarthritis associated after meniscus excision. Choosing an appropriate management strategy depends on multiple factors such as patient demographics and location of the tear. Physical therapy remains a first-line treatment for knee pain secondary to meniscus tear and should be pursued in the setting of acute and chronic knee pain. Furthermore, there is a growing amount of evidence showing that elderly patients with complex meniscus tears in the setting of degenerative arthritis should not undergo arthroscopic surgery. Direct meniscus repair remains an option in ideal patients who are young, healthy, and have tears near the more vascular periphery of the meniscus but it is not suitable for all patients. Use of orthobiologics such as platelet-rich plasma and mesenchymal stem cells have shown promise in augmenting surgical repairs or as standalone treatments, although research for their use in meniscal tear management is limited.


Assuntos
Lesões do Menisco Tibial/terapia , Tecido Adiposo/citologia , Tecido Adiposo/transplante , Artroscopia , Terapia por Exercício , Humanos , Transplante de Células-Tronco Mesenquimais , Procedimentos Ortopédicos , Modalidades de Fisioterapia , Plasma Rico em Plaquetas
17.
PM R ; 11(2): 177-191, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30010050

RESUMO

Regenerative medicine in the context of musculoskeletal injury is a broad term that offers potential therapeutic solutions to restore or repair damaged tissue. The current focus in recent literature and clinical practice has been on cell based therapy. In particular, much attention has been centered on autologous bone marrow concentrate and adipose-derived mesenchymal stem cells (MSCs) for cartilage and tendon disorders. This article provides an overview of MSC-derived therapy and offers a comprehensive review of adipose- and bone marrow-derived MSC therapy in primary knee osteoarthritis. LEVEL OF EVIDENCE: IV.


Assuntos
Tecido Adiposo/citologia , Células da Medula Óssea/citologia , Transplante de Medula Óssea/métodos , Transplante de Células-Tronco Mesenquimais/métodos , Osteoartrite do Joelho/terapia , Medicina Regenerativa/métodos , Humanos
19.
PM R ; 9(12): 1268-1277, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28606838

RESUMO

Ultrasound (US) is a therapeutic modality that has been used in the treatment of musculoskeletal conditions for decades. In recent years, there have been technological advancements using low-intensity pulsed ultrasound (LIPUS) as a clinical modality. The purpose of this review was to critically examine the medical literature to determine the effects of LIPUS on the chondrogenic properties of knee osteoarthritis. A literature search of 3 major databases (PubMed, Scopus, and EMBASE) was performed. Two independent physician reviewers screened titles and abstracts, yielding a total of 18 relevant articles after the inclusion and exclusion criteria were applied. Results favored that LIPUS has a promising effect on the cellular elements in articular cartilage, specifically on chondrocytes in knee osteoarthritis. Although the use of LIPUS is encouraging based on basic science and preclinical data, there is a paucity of evidence with respect to humans. Consequently, there is insufficient evidence to recommend for or against LIPUS in clinical OA populations. We suggest future directions for research centered on LIPUS in both human and animal models to delineate the effect on the biologic properties of cartilage in knee osteoarthritis. LEVEL OF EVIDENCE: III.


Assuntos
Cartilagem Articular/efeitos da radiação , Osteoartrite do Joelho/terapia , Terapia por Ultrassom/métodos , Ondas Ultrassônicas , Humanos
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