Allan K. Mishra, MD, Menlo Medical Clinic: Stanford Hospital, Menlo Park, CA
Platelet rich plasma precision involvs understanding the appropriate indication, formulation, and rehabilitation.
Jason L. Dragoo, MD, Stanford School of Medicine, Redwood City, CA
The 3 largest clinical trials showing benefit of PRP vs. steroid or dry needling for tendinopathy have 1 major similarity: Their PRP preparations all used leukocyte-rich formulations.
A PRP formulation eliminating white blood cells, neutrophils & red blood cells is recommended based on research performed when treating knee osteoarthritis. Early pre-clinical studies show a potential beneficial roll utilizing platelet poor plasma (PPP) by eliminating the platelets for muscle tears. More studies are needed to confirm findings.
Peter A. Everts, PhD, Da Vinci Clinic, Eindhoven, Netherlands
Regarding the concentration of platelets in PRP for orthopedic injuries: More is not necessarily better and less may not necessarily be therapeutic. We have yet to definitively outline the best concentrations for every application.
Kenneth R. Mautner, MD, Emory Sports Medicine Center, Atlanta, GA
There is insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries, and there is some evidence to show that cryotherapy may decrease platelet activation. Practitioners using PRP may consider avoiding ice packs to treated areas for 24-48 hours.
BONE MARROW CONCENTRATE
Shane A. Shapiro, MD, Mayo Clinic College of Medicine Department of Orthopedic Surgery, Jacksonville, FL
Cited ground-breaking research: Chahla J – Orthop J Sports Med (2016) Concentrated Bone Marrow Aspirate for the Treatment of Chondral Injuries and Osteoarthritis of the Knee A Systematic Review of Outcomes: http://ojs.sagepub.com/content/4/1/2325967115625481.short
– Pain improvements after BMAC injection for symptomatic knee arthritis not typically represent significant improvements in T2 mapping for knee cartilage.
Josh Hackel, MD, Andrews Orthopaedic & Sports Medicine Center, Gulf Breeze, FL
After an ACL injury, the effusion fluid contains a large concentration of stem cells and regenerative cytokines. Future research will focus on the potential for harnessing this fluid as a rich source for othobiologic procedures.
BMC Expert Panel Discussion with Live & Online Attendee Q&A
Bone Marrow Aspirate Approach: Fluoro, Ultrasound or Blind? Multiple Sights or One Sight? Drill or No Drill?
Both Dr. Karli and Dr. Lutz have seen similar cases of acute knee effusions after using both BMA/BMAC and PRP, and both agree that the incidence of significant post-procedure swelling is less with BMA/BMAC alone.
Laurence McClish, MD, Sierra Stem Cell Institute, Reno, NV
Andrew C. Wesely, MD, Sierra Stem Cell Institute, Reno, NV
A clinically useful stromal vascular fraction can be derived using our technique of lipoaspiration and emulsification WITHOUT culture or enzyme use. Derived cells largely intact and viable, with high numbers of CD34+ stem cells. We have observed no major complications/infections from 18 patients.
Randy B. Miller, MD, Cosmetic & Reconstructive Surgery, Coconut Grove, FL
In vitro studies have suggested that PRP improves the viability, proliferation, and differentiation of adipose stem cells when added to culture media.
PRP + adipose stem cells seems to be more effective than PRP alone for treating pain related to chronic wrist arthritis, with positive effects seen up to 18-24 months.
Ramón Cugat, MD, PhD, Garcia Cugat Foundation, Barcelona, Spain
In patients status-post ACL surgery, anterior knee pain is common at the patellar tendon graft site. Randomized patients treated with leukocyte-reduced PRP at the donor site showed statistically significant differences at 4 month follow-up compared to a control group. Results normalized between groups at 6 months and beyond.
Lipoaspirate Expert Panel Discussion with Live & Online Attendee Q&A
Adipose vs Bone Marrow: When & Why?
Regarding decisions between using adipose vs bone marrow derived cell treatments for knee OA: Both Dr. Gobbi and Dr. Castellanos mentioned the following: Patients ~70 years or older may have suboptimal bone marrow quality, and therefore this population may benefit more from adipose-derived stem cell treatments.
TOBI 2016 Day 2 – Another outstanding day, including SPINE, CARTILAGE & BONE, and Workshop Intensives:
11.5 AMA AMA PRA Category 1 CME available
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