Lower Extremity PRP,  Stem Cell and Laser Research

Here we list important hip, knee, and foot/ankle basic science and clinical research on the use of PRP and stem cells and lasers for 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.

Cell Therapy Versus Simultaneous Contralateral Decompression In Symptomatic Corticosteroid Osteonecrosis: A Thirty Year Follow-Up Prospective Randomized Study Of One Hundred And Twenty Five Adult Patients

Philippe Hernigou, MD, Dubory A, Homma Y, et al.

2018 Article Summary (International Orthopedics)

Patient who received an injection with on average 90,000 CFU/s had significantly better outcomes 30 years later compared to patients with core decompression alone.  Patients treated with bone marrow concentrate had a 28% incidence of collapse compared to a 72% rate of collapse for patients who did not receive the BMC injection. Patients treated with bone marrow concentrate had a 24% incidence of hip replacement over 30 years versus a 76% incidence of hip replacement in patients who did not receive the BMC injection.

Knee

Bone Marrow Mesenchymal Stromal Cells in Patients with Osteoarthritis Results in Overall Improvement in Pain and Symptoms and Reduces Synovial Inflammation

Interesting Canadian pilot study (N=12) on cultured bone marrow derived MSCs used for knee osteoarthritis (KL3 and KL4) This is one of the very few published papers showing dose dependent outcomes (higher dose...better outcome) with autologous cultured bone marrow derived MSCs.
Of note is that the MRIs didn't change out to one year.
We can't culture stem cells and use them without specific FDA regulatory approval in the USA so even the lowest dose in this study (1 million, 10 million, 50 million) is far out of reach of our same day procedures where we can expect to be delivering 5,000 up to 50,000 MSCs depending on how much marrow we harvest and whether it is centrifuged or not.

Does addition of low-level laser therapy (LLLT) in conservative care of knee arthritis successfully postpone the need for joint replacement?

Conclusion: After a follow-up of 6 years, patients clearly benefited from treatment with protocol B as only one knee needed joint replacement surgery, while nine patients treated with protocol A needed surgery (p < 0.05). We conclude low-level laser therapy should be incorporated into standard conservative treatment protocol for symptomatic knee arthritis.

The laser used was a Class 3b low level laser. Patients were treated 3x/week for 3 months (12 treatments)

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.

Subchondral Stem Cell Therapy Versus Contralateral Total Knee Arthroplasty For Osteoarthritis Following Secondary Osteonecrosis Of The Knee

Philippe Hernigou, MD, Auregan JC, et al.

2018 Article Summary (International Orthopedics)

30 patients were treated with a knee replacement for one knee and subchondral bone marrow concentrate injections for the other knee.  After 12 years, 70% of patients preferred the knee that did NOT have the knee replacement.  Additionally, the knees with joint replacements had multiple other complications including a 20% surgical revision rate over 12 years.

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.

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.