Lower Extremity PRP and Stem Cell Research

Here we list important hip, knee, and foot/ankle basic science and clinical research on the use of PRP and stem cells in musculoskeletal conditions.   This list is constantly reviewed and updated as a reference source and to help guide our treatment recommendations. 
     As a research institute,  The Dallas PRP and Stem Cell Institute collects registry data on all of our PRP and Stem Cell treatments to help fine tune our patient care and to publish in peer reviewed journals so that we may contribute to this rapidly growing area of orthopedics

Hip

Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis.

Battaglia M, Guaraldi F, Vannini F, Rossi G, Timoncini A, Buda R, Giannini S.
Orthopedics. 2013 Dec;36(12):e1501-8.

Intra-articular injections of PRP are efficacious in terms of functional improvement and pain reduction but are not superior to HA in patients with symptomatic hip OA at 12-month follow-up.

Hip osteoarthritis in dogs: a randomized study using mesenchymal stem cells from adipose tissue and plasma rich in growth factors.

Cuervo B, Rubio M, Sopena J, Dominguez JM, Vilar J, Morales M, Cugat R, Carrillo JM.
Int J Mol Sci. 2014 Jul 31;15(8):13437-60.

Our findings show that aMSCs and PRGF are safe and effective in the functional analysis at 1, 3 and 6 months; provide a significant improvement, reducing dog's pain, and improving physical function. With respect to basal levels for every parameter in patients with hip OA, aMSCs showed better results at 6 months.

Knee

Effect of leukocyte concentration on the efficacy of platelet rich plasma in the treatment of knee osteoarthritis

Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ.
American J Of Sports Med.  March 2016. 44(3): 792-800.

CONCLUSIONS:
This is a level 2 Meta-Analysis study of 6 level 1 studies and 3 level 2 studies.  The total number of patients is 1055. Leukocyte poor platelet rich plasma (LP-PRP) resulted in improved functional scores compared to hyaluronic acid or placebo or leukocyte rich platelet rich plasma (LR-PRP).  All 3 groups had similar subjective  IKDC score improvements.

Efficacy of Intra-articular PRP Injections In Knee Osteoarthritis : A Systematic Review

Meheux, CJ, McCulloch PC, Lintner DM, Varner KE, Harris JD.
Arthroscopy. Mar 2016. 32(3). Pp 495-505.

CONCLUSIONS:
This paper is a level 1 meta-analysis of 6 human, in vivo, Level 1 studies. In patients with symptomatic knee OA, PRP injections resulted in significant clinical improvements up to 12 months postinjection. Clinical and WOMAC scores were better with PRP versus HA from 3-12 months postop. This meta-analysis did not evaluate LP-PRP and LR-PRP or steriods in this study.

Viscosupplementation for Osteoarthritis of the Knee: A Systematic Review of the Evidence

Jevsevar D, Donnelly P, Brown GA, Cummins DS.
JBJS. 2015 Dec 16; 97(24): 2047-60.

CONCLUSIONS:
Meta-analysis of only the double-blinded, sham-controlled trials with at least sixty patients did not show clinically important differences of HA treatment over placebo. When all literature was added to the analysis, the overall effect was greater but was biased toward stronger treatment effects because of the influence of nonblinded or improperly blinded trials.

Adult human mesenchymal stem cells delivered via intra-articular injection to the knee following partial medial menisectomy: a randomized, double blind, controlled study.

Vangsness CT, Farr J, Boyd J, LeRoux-Williams M, et al.
JBJS. 2014 Jan 15;96(2):90-98.

At 12 months post arthroscopic partial menisectomy, there was evidence of significant meniscus regeneration and improvement in knee pain following single dose treatment with allogeneic mesenchymal stem cells (MSCs).  The largest increase in meniscal volume was seen in patients receiving the lower of two tested doses of MSCs (50,000,000 stem cells)

Concentrated bone marrow aspirate improves full thickness cartilage repair compared with microfracture in the equine model

Fortier LA, Potter HG, et al.
JBJS. 2010 Aug 18;92(10):1927-1937.

Delivery of bone marrow aspirate concentrate can result in healing of acute full thickness cartilage defects that is superior to that of microfracture alone in an equine model.

"Regenerative repair of damaged meniscus with autologous adipose tissue-derived stem cells."

Pak J, Lee JH, Lee SH.
Biomed Res Int. 2014;2014:436029.

Here, we present a review, highlighting the possible regenerative mechanisms of damaged meniscus with MSCs (especially adipose tissue-derived stem cells (ASCs)), along with a case of successful repair of torn meniscus with significant reduction of knee pain by percutaneous injection of autologous ASCs into an adult human knee.

Knee Osteoarthritis Injection Choices: Platelet- Rich Plasma (PRP) Versus Hyaluronic Acid (A one-year randomized clinical trial).

Raeissadat SA, Rayegani SM, Hassanabadi H, Fathi M, Ghorbani E, Babaee M, Azma K.
Clin Med Insights Arthritis Musculoskelet Disord. 2015 Jan 7;8:1-8.

This study suggests that PRP injection is better than hyaluronic acid injection in reducing symptoms and improving quality of life and is a therapeutic option in select patients with knee arthritis who have not responded to conventional treatment.

Does intra articular platelet rich plasma injection improve function, pain, and quality of life in patients with osteoarthritis of the knee?  A randomized clinical trial. 

Rayegani SM, Raeissadat SA, Taheri MS, Babee M, Bahrami MH, Eliaspour D, Ghorbani E.
Orthop Rev (Pavia). 2014 Sep 18;6(3):5405.

This randomized clinical study looked at patients with knee arthritis. 31 patients had 2 PRP injections one month apart and 31 patients had no PRP injections.  Both groups had physical therapy.  The PRP group had statistically significant better WOMAC and SF-36 scores 6 months after treatment.

Foot/Ankle

Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial.

Laver L, Carmont MR, McConkey MO, Palmanovich E, Yaacobi E, Mann G, Nyska M, Kots E, Mei-Dan O.
Knee Surg Sports Traumatol Arthrosc. 2014 Jun 18

Athletes suffering from high ankle sprains benefit from ultrasound-guided PRP injections with a shorter RTP, re-stabilization of the syndesmosis joint and less long-term residual pain. LEVEL OF EVIDENCE: II.

A single platelet-rich plasma injection for chronic midsubstance achilles tendinopathy: a retrospective preliminary analysis.

Murawski CD, Smyth NA, Newman H, Kennedy JG.
Foot Ankle Spec. 2014 Oct;7(5):372-6.

A retrospective evaluation of patients receiving a single PRP injection for chronic midsubstance Achilles tendinopathy revealed that 78% had experienced clinical improvement and had avoided surgical intervention at 6-month follow-up.