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1.
Br J Sports Med ; 2021 May 09.
Artigo em Inglês | MEDLINE | ID: mdl-33967025

RESUMO

Sports ultrasound is commonly used by sports medicine physicians to enhance diagnostic and procedural accuracy. This expert consensus statement serves as an update to the 2015 American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Although written in the context of the American sports medicine fellowship training model, we present a stepwise progression in both diagnostic and interventional sports ultrasound that may be applicable to the broader sports medicine community. The curriculum is divided into 12 units with each unit including didactic instructional sessions, practical hands-on instruction, independent scanning practice sessions and mentored clinical experience. To assist with prioritisation of learning, we have organised relevant pathology and procedures as essential, desirable and optional The expanded content can serve as an outline for continuing education postfellowship or for any physician to further advance their sports ultrasound knowledge and skill. We also provide updated scanning protocols, sample milestones and a sample objective structured clinical examination to aid fellowships with implementation of the curriculum and ongoing assessment of fellow progress.

2.
Clin J Sport Med ; 2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-33958521

RESUMO

ABSTRACT: Sports ultrasound is commonly used by sports medicine physicians to enhance diagnostic and procedural accuracy. This expert consensus statement serves as an update to the 2015 American Medical Society for Sports Medicine recommended sports ultrasound curriculum for sports medicine fellowships. Although written in the context of the American sports medicine fellowship training model, we present a stepwise progression in both diagnostic and interventional sports ultrasound that may be applicable to the broader sports medicine community. The curriculum is divided into 12 units with each unit including didactic instructional sessions, practical hands-on instruction, independent scanning practice sessions, and mentored clinical experience. To assist with prioritization of learning, we have organized relevant pathology and procedures as essential, desirable, and optional. The expanded content can serve as an outline for continuing education postfellowship or for any physician to further advance their sports ultrasound knowledge and skill. We also provide updated scanning protocols, sample milestones, and a sample objective structured clinical examination (OSCE) to aid fellowships with implementation of the curriculum and ongoing assessment of fellow progress.

4.
Tech Vasc Interv Radiol ; 23(4): 100704, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33308583

RESUMO

Biologics are a growing field that has shown immense promise for the treatment of musculoskeletal conditions both in orthopedic sports medicine and interventional pain management. These procedures utilize injection of supraphysiologic levels of platelets and growth factors to invoke the body's own inflammatory cascade to augment the healing of many bony and soft tissue conditions. While many patients improve with conservative care, there is a need to address the gap between those that improve with rehabilitation alone and those who ultimately require operative management. Orthobiologic procedures have the potential to fill this void. The purpose of this review is to summarize the basic science, evidence for use, and post-injection rehabilitation concepts of platelet-rich plasma (PRP) and mesenchymal stromal cells (MSCs) as they pertain to joints, tendons, ligaments, and the spine.


Assuntos
Transplante de Células-Tronco Mesenquimais , Doenças Musculoesqueléticas/terapia , Plasma Rico em Plaquetas , Animais , Medicina Baseada em Evidências , Humanos , Transplante de Células-Tronco Mesenquimais/efeitos adversos , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/fisiopatologia , Resultado do Tratamento
5.
Int J Mol Sci ; 21(20)2020 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-33096812

RESUMO

Emerging autologous cellular therapies that utilize platelet-rich plasma (PRP) applications have the potential to play adjunctive roles in a variety of regenerative medicine treatment plans. There is a global unmet need for tissue repair strategies to treat musculoskeletal (MSK) and spinal disorders, osteoarthritis (OA), and patients with chronic complex and recalcitrant wounds. PRP therapy is based on the fact that platelet growth factors (PGFs) support the three phases of wound healing and repair cascade (inflammation, proliferation, remodeling). Many different PRP formulations have been evaluated, originating from human, in vitro, and animal studies. However, recommendations from in vitro and animal research often lead to different clinical outcomes because it is difficult to translate non-clinical study outcomes and methodology recommendations to human clinical treatment protocols. In recent years, progress has been made in understanding PRP technology and the concepts for bioformulation, and new research directives and new indications have been suggested. In this review, we will discuss recent developments regarding PRP preparation and composition regarding platelet dosing, leukocyte activities concerning innate and adaptive immunomodulation, serotonin (5-HT) effects, and pain killing. Furthermore, we discuss PRP mechanisms related to inflammation and angiogenesis in tissue repair and regenerative processes. Lastly, we will review the effect of certain drugs on PRP activity, and the combination of PRP and rehabilitation protocols.

6.
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
7.
Stem Cells Transl Med ; 8(11): 1149-1156, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31328447

RESUMO

This study aimed to determine whether autologous orthobiologic tissue source affects pain and functional outcomes in patients with symptomatic knee osteoarthritis (OA) who received microfragmented adipose tissue (MFAT) or bone marrow aspirate concentrate (BMAC) injection. We retrospectively reviewed prospectively collected data from patients who received BMAC or MFAT injection for symptomatic knee OA. Patients completed baseline and follow-up surveys. Each survey included the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, Emory Quality of Life (EQOL) questionnaire, and Visual Analog Scale (VAS) for pain. The follow-up responses were compared with baseline for all patients and between BMAC and MFAT groups. A total of 110 patients met inclusion criteria, with 76 patients (BMAC 41, MFAT 35) and 106 knees (BMAC 58, MFAT 48) having appropriate follow-up data. The BMAC group included 17 females and 24 males, with a mean age of 59 ± 11 years. The MFAT group included 23 females and 12 males, with a mean age of 63 ± 11 years. Minimum follow-up time was 0.5 years. Mean follow-up time was 1.80 ± 0.88 years for BMAC and 1.09 ± 0.49 years for MFAT. Both groups had significant improvement in EQOL, VAS, and all KOOS parameters preprocedure versus postprocedure (p < .001). There was not a significant difference when comparing postprocedure scores between groups (p = .09, .38, .63, .94, .17, .15, .70, respectively). These data demonstrate significant improvement in pain and function with both MFAT and BMAC injections in patients with symptomatic knee OA without a significant difference in improvement when comparing the two autologous tissue sources. Stem Cells Translational Medicine 2019;8:1149-1156.


Assuntos
Tecido Adiposo/citologia , Células da Medula Óssea/citologia , Transplante de Medula Óssea , Osteoartrite do Joelho/terapia , Qualidade de Vida , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/patologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos
8.
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.

9.
J Shoulder Elbow Surg ; 28(1): 112-119, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30551782

RESUMO

BACKGROUND: Medial epicondylitis and lateral epicondylitis are among the most common elbow pathologies affecting people aged between 40 and 50 years. Although epicondylitis is often a self-limiting condition that improves with conservative treatment, the condition can be difficult to eradicate. The purpose of this study was to compare the effectiveness of platelet-rich plasma (PRP) injections and ultrasound-guided percutaneous tenotomy (Tenex) for the treatment of medial or lateral epicondylitis. Our hypothesis was that the Tenex procedure would not be inferior to PRP injections in the treatment of medial or lateral epicondylitis. METHODS: In this retrospective review, 62 of 75 patients were available for contact via phone and e-mail to complete post-procedure patient-reported outcome surveys. Subjective assessment of pain and function included a visual analog scale for pain; the Quick Disabilities of the Arm, Shoulder and Hand questionnaire; and the EuroQol-5D questionnaire. The inclusion criteria included age of 18 years or older and previous failure of nonoperative treatment. RESULTS: The average ages in the PRP and Tenex groups were 47 years and 51 years, respectively. The PRP cohort (n = 32) included 10 female and 22 male patients, whereas the Tenex cohort (n = 30) included 12 female and 18 male patients. The PRP and Tenex groups both demonstrated clinical and statistical improvement in visual analog scale pain scores; Quick Disabilities of the Arm, Shoulder and Hand scores; and EuroQol-5D scores. No statistically significant difference was found between the 2 treatment modalities. CONCLUSION: The PRP and Tenex procedures were both successful in producing clinically and statistically significant improvements in pain, function, and quality of life.


Assuntos
Plasma Rico em Plaquetas , Cotovelo de Tenista/terapia , Tenotomia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
10.
PM R ; 10(9): 979-983, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29428875

RESUMO

Proximal tensor fascia lata tendinopathy at its origin on the anterior superior iliac crest is one potential cause of lateral hip pain. However, there is limited literature regarding the mechanism, disease course, or management of this condition. There is growing evidence supporting the effective treatment of percutaneous needle tenotomy (PNT) for chronic tendinopathy. Only a single case series has examined the efficacy of PNT for tendinopathy about the hip and pelvis. Presented here are examples of 2 cases of chronic recalcitrant proximal ultrasound confirmed tensor fascia lata (tendinopathy effectively treated with ultrasound-guided PNT. LEVEL OF EVIDENCE: IV.


Assuntos
Dor Crônica/cirurgia , Fascia Lata/lesões , Tendinopatia/diagnóstico por imagem , Tendinopatia/cirurgia , Tenotomia , Ultrassonografia de Intervenção , Dor Crônica/diagnóstico por imagem , Dor Crônica/etiologia , Feminino , Humanos , Pessoa de Meia-Idade
12.
J Ultrasound Med ; 35(11): 2517-2521, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27738295

RESUMO

The purpose of this series was to retrospectively characterize the ultrasound findings of delayed-onset muscle soreness (DOMS). The Institutional Review Board approved our study, and informed consent was waived. A retrospective search of radiology reports using the key phrase "delayed-onset muscle soreness" and key word "DOMS" from 2001 to 2015 and teaching files was completed to identify cases. The sonograms were reviewed by 3 fellowship-trained musculoskeletal radiologists by consensus. Sonograms were retrospectively characterized with respect to echogenicity (hypoechoic, isoechoic, or hyperechoic), distribution of muscle involvement, and intramuscular pattern (focal versus diffuse and well defined versus poorly defined). Images were also reviewed for muscle enlargement, fluid collection, muscle fiber disruption, and increased flow on color or power Doppler imaging. There were a total of 6 patients identified (5 male and 1 female). The average age was 22 years (range, 7-44 years). Of the 6 patients, there were a total of 11 affected muscles in 7 extremities (1 bilateral case). The involved muscles were in the upper extremity: triceps brachii in 27% (3 of 11), biceps brachii in 18% (2 of 11), brachialis in 18% (2 of 11), brachioradialis in 18% (2 of 11), infraspinatus in 9% (1 of 11), and deltoid in 9% (1 of 11). On ultrasound imaging, the abnormal muscle was hyperechoic in 100% (11 of 11), well defined in 73% (8 of 11), poorly defined in 27% (3 of 11), diffuse in 73% (8 of 11), and focal in 27% (3 of 11). Increased muscle size was found in 82% (9 of 11) and minimal hyperemia in 87.5% (7 of 8). The ultrasound findings of DOMS include hyperechoic involvement of an upper extremity muscle, most commonly appearing well defined and diffuse with increased muscle size and minimal hyperemia.


Assuntos
Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiopatologia , Mialgia/diagnóstico por imagem , Mialgia/fisiopatologia , Ultrassonografia , Adolescente , Adulto , Braço/diagnóstico por imagem , Braço/fisiopatologia , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Adulto Jovem
14.
PM R ; 7(9): 1007-1010, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25843372

RESUMO

Distal biceps tendinopathy is an uncommon but increasingly diagnosed condition in persons with elbow pain. When traditional treatments are unsuccessful, practitioners have performed ultrasound (US)-guided tendon injections in this region using an anterior approach. Although success has been reported with this technique, this approach may lead to neurovascular injury. This case report is the first in the literature to describe a US-guided distal bicep tendon injection using a posterior approach. The patient had an excellent clinical outcome with no adverse events. This outcome suggests that a US-guided posterior percutaneous tendon injection might be a safe, viable, nonsurgical option for recalcitrant distal biceps tendinopathy.


Assuntos
Artralgia/etiologia , Articulação do Cotovelo , Plasma Rico em Plaquetas , Tendinopatia/tratamento farmacológico , Ultrassonografia de Intervenção/métodos , Artralgia/diagnóstico por imagem , Artralgia/tratamento farmacológico , Seguimentos , Humanos , Injeções Intralesionais/métodos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Tendinopatia/complicações , Tendinopatia/diagnóstico por imagem , Tendões
15.
PM R ; 7(4 Suppl): S33-S40, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25864658

RESUMO

Treatment options for muscle, tendon, and ligament injuries span a constantly evolving spectrum. For years, treatments focused on symptomatic relief. Closer scrutiny of symptomatic treatment suggests that the provision of transient relief of symptoms may have caused more harm than good. Cortisone injections provide a trade-off of short-term relief for poorer long-term outcomes. When conventional treatment failed, patients have faced limited options including surgery, which has increased risk and limited efficacy. Regenerative injections offer a more robust option for soft tissue disease. Basic science and clinical studies show conflicting results to support the use of platelet-rich plasma injections for soft tissue disorders, and even fewer trials have focused on injectable stem cells with limited findings. Additional studies are needed to determine the potential benefits of this regenerative therapy.


Assuntos
Ligamentos/lesões , Transplante de Células-Tronco/métodos , Células-Tronco/citologia , Traumatismos dos Tendões/terapia , Humanos , Injeções
16.
PM R ; 7(4 Suppl): S53-S59, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25864661

RESUMO

Autologous cell therapies including platelet-rich plasma (PRP) and bone marrow concentrate (BMC) are increasingly popular options for soft tissue and joint-related diseases. Despite increased clinical application, conflicting research has been published regarding the efficacy of PRP, and few clinical publications pertaining to BMC are available. Preparations of PRP (and BMC) can vary in many areas, including platelet concentration, number of white blood cells, presence or absence of red blood cells, and activation status of the preparation. The potential effect of PRP characteristics on PRP efficacy is often not well understood by the treating clinician, and PRP characteristics, as well as the volume of PRP delivered, are unfortunately not included in the methods of many published research articles. It is essential to establish a standard reporting system for PRP that facilitates communication and the interpretation and synthesis of scientific investigations. Herein, the authors propose a new PRP classification system reflecting important PRP characteristics based on contemporary literature and recommend adoption of minimal standards for PRP reporting in scientific investigations. Widespread adoption of these recommendations will facilitate interpretation and comparison of clinical studies and promote scientifically based progress in the field of regenerative medicine.


Assuntos
Pesquisa Biomédica , Ortopedia/métodos , Plasma Rico em Plaquetas , Terminologia como Assunto , Pesquisa Biomédica/classificação , Pesquisa Biomédica/métodos , Pesquisa Biomédica/normas , Humanos
17.
Clin J Sport Med ; 25(4): 355-60, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25353721

RESUMO

OBJECTIVE: To investigate whether attention deficit hyperactivity disorder (ADHD) influences postconcussion recovery, as measured by computerized neurocognitive testing. DESIGN: This is a retrospective case control study. SETTING: Computer laboratories across 10 high schools in the greater Atlanta, Georgia area. PARTICIPANTS: Immediate postconcussion assessment and cognitive testing (ImPACT) scores of 70 athletes with a self-reported diagnosis of ADHD and who sustained a sport-related concussion were compared with a randomly selected age-matched control group. Immediate postconcussion assessment and cognitive testing scores over a 5-year interval were reviewed for inclusion. MAIN OUTCOME MEASURES: Postconcussion recovery was defined as a return to equivalent baseline neurocognitive score on the ImPACT battery, and a concussion symptom score of ≤7. RESULTS: Athletes with ADHD had on average a longer time to recovery when compared with the control group (16.5 days compared with 13.5 days), although not statistically significant. The number of previous concussions did not have any effect on the rate of recovery in the ADHD or the control group. In addition, baseline neurocognitive testing did not statistically differ between the 2 groups, except in verbal memory. CONCLUSIONS: Although not statistically significant, youth athletes with ADHD took on average 3 days longer to return to baseline neurocognitive testing compared with a control group without ADHD. CLINICAL RELEVANCE: Youth athletes with ADHD may have a marginally prolonged recovery as indexed by neurocognitive testing and should be considered when prognosticating time to recovery in this subset of student athletes.


Assuntos
Traumatismos em Atletas/psicologia , Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Concussão Encefálica/psicologia , Recuperação de Função Fisiológica , Adolescente , Atletas , Traumatismos em Atletas/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Concussão Encefálica/epidemiologia , Estudos de Casos e Controles , Comorbidade , Diagnóstico por Computador , Feminino , Georgia/epidemiologia , Humanos , Masculino , Memória , Testes Neuropsicológicos , Estudos Retrospectivos , Fatores de Tempo
20.
PM R ; 5(3): 169-75, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23399297

RESUMO

OBJECTIVE: To determine whether ultrasound-guided platelet-rich plasma (PRP) injections are an effective treatment for chronic tendinopathies. DESIGN: A retrospective, cross-sectional survey. SETTING: Four academic sports medicine centers from across the United States. PATIENTS: A total of 180 men and women between the ages of 18 and 75 years who received ultrasound-guided PRP injections for tendinopathy refractory to conventional treatments. INTERVENTIONS: Survey on satisfaction and functional outcome. MAIN OUTCOME MEASUREMENTS: Perceived improvement in symptoms at least 6 months after treatment, perceived change in visual analog scale score, assessment of functional pain, and overall satisfaction. RESULTS: On average, patients were 48 years old, had symptoms for a median of 18 months before treatment, and answered the survey on average 15 months after treatment. Overall, 82% of patients indicated moderate to complete improvement in symptoms. The most common injection sites were the lateral epicondyle, Achilles, and patellar tendons. Other sites treated included the rotator cuff, hamstring, gluteus medius, and medial epicondyle, among others. Furthermore, 60% of patients received only 1 injection, 30% received 2 injections, and 10% received 3 or more injections. Patients' perceived decrease in visual analog scale score was 75%, from 7.0 ± 1.8 to 1.8 ± 2.0 (-5.2, SD 2.7, 95% confidence interval -5.65 to -4.86, P < .0001). In addition, at follow-up, 95% of patients reported having no pain at rest that disrupted their activities of daily living and 68% reported no pain during activities. A total of 85% of patients were satisfied with the procedure. CONCLUSIONS: In this retrospective study, in which we evaluated administration of PRP for chronic tendinopathy, we found that the majority of patients reported a moderate (>50%) improvement in pain symptoms.


Assuntos
Plasma Rico em Plaquetas , Tendinopatia/terapia , Estudos Transversais , Feminino , Humanos , Injeções Intra-Articulares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Satisfação do Paciente , Estudos Retrospectivos , Ultrassonografia de Intervenção
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