UPPER EXTREMITY PRP, STEM CELL, AND LASER RESEARCH

Here we list important shoulder, elbow, and hand/wrist basic science and clinical research on the use of PRP,  stem cells, and LASER 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.

Shoulder

Biologic Augmentation Of Rotator Cuff Repair With Mesenchymal Stem Cells During Arthroscopy Improves Healing And Prevents Further Tears: A Case-controlled Study

Philippe Hernigou, MD, et. al.

2014 Article Summary (International Orthopedics)

45 patients with rotator cuff tears had surgical repair augmented with 12cc of bone marrow concentrate with 8cc placed into the greater tuberosity and 4 cc placed a the tendon bone interface.  Average total CFU was 51,000.  100% of BMC augmented repair group were healed at 6 months versus 67% in the control group.  At 10 years, 87% of the BMC augmented repair group rotator cuff repairs were still intact versus 44% in the control group.

Regenerative medicine in rotator cuff injuries.

Randelli P, Randelli F, Ragone V, Menon A, D'Ambrosi R, Cucchi D, Cabitza P, Banfi G.
Biomed Res Int. 2014;2014:129515.

Stem cells therapies represent a novel frontier in the management of rotator cuff disease that required further basic and clinical research.

Effectiveness of Platelet-rich Plasma Injection for Rotator Cuff Tendinopathy: A Prospective Open-label Study.

Scarpone M, Rabago D, Snell E, Demeo P, Ruppert K, Pritchard P, Arbogast G, Wilson JJ, Balzano JF.
Glob Adv Health Med. 2013 Mar;2(2):26-31.

A single ultrasound-guided, intralesional injection of PRP resulted in safe, significant, sustained improvement of pain, function, and MRI outcomes in participants with refractory RCT.

Intralesional injection of partial thickness rotator cuff tears

Paper presented at 2014 RSNA meeting in Chicago

A retrospective study with 240 patients in 2 groups...one with PRP injection and one with medicine/therapy. MRI done before injecting PRP into tendon defect and at 4 years after injection. For group getting PRP injection: 28% improvement by MRI and 58% improvement by VAS at 4 years.

Rotator Cuff Healing With and Without Platelet Rich Plasma

Don Buford, MD, RMSK

A prospective cohort study with 50 patients in each cohort.  Patients with rotator cuff tears up to 3cm in size received 5-6 cc of autologous LR-PRP at the tendon bone interface at the end of the surgical repair.  The addition of PRP to the rotator cuff repair resulted in no change in rotator cuff healing time or in the percentage of repairs that were healed at 6 months.

Journal of Arthroscopy, May, 2011; Vol 27, Issue 5, Pages e37-e38

Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial.

January, 2019 Study in Clinical Rehabilitation.  Authors are from Spain.

Summary:  20 patients in the LASER group versus the sham group followed for 3 months after 15 treatments (5 days/wk for 3 weeks)

The effect of high-intensity laser therapy plus exercise is not higher than exercise alone to reduce pain and improve functionality in patients with subacromial syndrome.

Laser Acupuncture Treatment Improves Pain and Functional Status in Patients with Subacromial Impingement Syndrome: A Randomized, Double-Blind, Sham-Controlled Study.
May, 2017. Journal of Pain Medicine
73 patients divided into Treatment and Sham groups.
Treatment group: low level(100mV)  850nm LASER acupuncture with 40J at 11 points
LASER group better at 3 weeks after 15 treatments.
Effectiveness of High-Intensity Laser Therapy in Subacromial Impingement Syndrome.

June 2016. Photomedicine And Laser Surgery.

42 patients, 3 sessions a week for 3 weeks.

Statistically significant decrease in VAS, UCLA, SPADI scores.

The efficacy of therapeutic ultrasound for rotator cuff tendinopathy: A systematic review and meta-analysis.

August, 2015. Physical Therapy In Sport.

A systematic review and meta-analysis on the efficacy of therapeutic ultrasound (US) in adults suffering from rotator cuff tendinopathy.

Laser therapy was found superior to therapeutic US in terms of pain reduction

Regenerative medicine in rotator cuff injuries.

Randelli P, Randelli F, Ragone V, Menon A, D'Ambrosi R, Cucchi D, Cabitza P, Banfi G.
Biomed Res Int. 2014;2014:129515.

Stem cells therapies represent a novel frontier in the management of rotator cuff disease that required further basic and clinical research.

Effectiveness of Platelet-rich Plasma Injection for Rotator Cuff Tendinopathy: A Prospective Open-label Study.

Scarpone M, Rabago D, Snell E, Demeo P, Ruppert K, Pritchard P, Arbogast G, Wilson JJ, Balzano JF.
Glob Adv Health Med. 2013 Mar;2(2):26-31.

A single ultrasound-guided, intralesional injection of PRP resulted in safe, significant, sustained improvement of pain, function, and MRI outcomes in participants with refractory RCT.

Intralesional injection of partial thickness rotator cuff tears

Paper presented at 2014 RSNA meeting in Chicago

A retrospective study with 240 patients in 2 groups...one with PRP injection and one with medicine/therapy. MRI done before injecting PRP into tendon defect and at 4 years after injection. For group getting PRP injection: 28% improvement by MRI and 58% improvement by VAS at 4 years.

Rotator Cuff Healing With and Without Platelet Rich Plasma

Don Buford, MD, RMSK

A prospective cohort study with 50 patients in each cohort.  Patients with rotator cuff tears up to 3cm in size received 5-6 cc of autologous LR-PRP at the tendon bone interface at the end of the surgical repair.  The addition of PRP to the rotator cuff repair resulted in no change in rotator cuff healing time or in the percentage of repairs that were healed at 6 months.

Journal of Arthroscopy, May, 2011; Vol 27, Issue 5, Pages e37-e38

Paper not published as of 2/2015 according to pubmed.com

Elbow

Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients.

Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, Ramsey ML, Karli DC, Rettig AC.
Am J Sports Med. 2014 Feb;42(2):463-71.

No significant differences were found at 12 weeks in this study. At 24 weeks, however, clinically meaningful improvements were found in patients treated with leukocyte-enriched PRP compared with an active control group.

Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials.

Krogh TP, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U, Bliddal H, Christensen R.
Am J Sports Med. 2013 Jun;41(6):1435-46.

This systematic review and network meta-analysis of randomized controlled trials found a paucity of evidence from unbiased trials on which to base treatment recommendations regarding injection therapies for lateral epicondylitis.

Treatment of partial ulnar collateral ligament tears in the elbow with platelet rich plasma

Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA. Am J Sports Med. 2013 Jul;41(7):1689-1694.

This was a retrospective review of 34 athletes with MRI documented partial thickness UCL tears.  All had failed at least 2 months of nonoperative treatment and an attempt to return to play.  All patients had one injection of PRP at the UCL. Average follow-up was 70 weeks. There were significant decreases in medial elbow joint space opening under valgus stress and in KJOC and DASH outcome scores. 88% returned to same level of play without complaints. 1/34 had persistent UCL instability and had surgery.

Platelet Rich Plasma Can Be Used To Successfully Treat Elbow Ulnar Collateral Ligament Insufficiency In High Level Throwers

Dines JS, Williams PN, ElAttrache N, Conte S, Tomcyzk T, Osbahr DC, Dines DM, Bradley J, Ahmad CS. Am J Orthop. 2016 Jul-Aug;(45), 296-300.

Retrospective review of 44 baseball players (6 pro, 14 college, 24 high school) treated with PRP for partial thickness UCL tears. 16 had 1 injection, 6 had 2 injections, and 22 had three injections.  Average age was 17 years.  Mean time to return to throw was 5 weeks.  Mean time to return to competition was 3 months.  These outcomes are significantly better than previously reported conservative treatment outcomes.

Platelet-Rich Plasma for Primary Treatment of Partial Ulnar Collateral Ligament Tears: MRI Correlation With Results

J. Banks Deal, MD,* Ed Smith, MD,* Wendell Heard, MD,* Michael J. O’Brien, MD,* and Felix H. Savoie, III, MD

November 2017. Orthopedic Journal of Sports Medicine.

22/23 (96%) patients with primary grade 2 UCL injuries returned to the same level of sport.

Patients received two injections spaced two weeks apart.

MRI followup was done showing ligament healing.

Hand/Wrist

Stem cells and biological approaches to treatment of wrist problems.

Chong AK, He M.
J Wrist Surg. 2013 Nov;2(4):315-8.