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chess9
01-13-2010, 03:25 AM
http://www.medpagetoday.com/Orthopedics/Orthopedics/17910?utm_content=GroupC&utm_medium=email&impressionId=1263354678737&utm_campaign=DailyHeadlines&utm_source=mSpoke&userid=86439

"Based on the questionnaire, both groups improved significantly from baseline through 24 weeks. Those getting plasma improved by 21.7 points, while those getting saline placebo improved by 20.5 points.

There was no significant difference between the groups at 24 weeks or at any other evaluation time point, the researchers found.

The improvement in both groups can probably be attributed to the exercise program, the researchers said, although part of it might be due to a placebo effect among those getting saline."

-Robert

ollinger
01-13-2010, 06:24 AM
The whole thing never made much sense to me. Dumping growth factors on a site doesn't mean growth/healing will occur in an ORGANIZED fashion. Random growth (known as "arthritis" when it occurs in a joint) is not a good thing.

larry10s
01-13-2010, 07:07 AM
robert the link did not come up for me but i trust your summary.we' see what future studies show since the initial ones seemed promising. it did make sense to me since you have an area of poor blood supply where the healing factors dont get to easily. bringing the mountain to mohammed seemed like it would be helpful to me.

ollinger
01-13-2010, 07:49 AM
Malignant tumors also have extremely rich blood supply, which is why they show up on contrast scans. Blood supply doesn't ORGANIZE the growth.

chess9
01-13-2010, 07:59 AM
Here's most of it:

Novel Tendon Shots Offered No Benefit over Exercise
By Michael Smith, North American Correspondent, MedPage Today
Published: January 12, 2010
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
for reading medical news





Copy the code below to embed audio on your website or blog:




An experimental drug-and-exercise therapy for chronic Achilles tendinopathy didn't work in a Dutch study, researchers said.

Injections of platelet-rich plasma (PRP) combined with eccentric exercise gave no better results than exercise alone, according to Robert de Vos, MD, of Erasmus University Medical Center in Rotterdam, and colleagues.

The finding comes from the first randomized, placebo-controlled trial of the therapy, which appears to be gaining popularity on the basis of more limited studies, De Vos and colleagues reported in the Jan. 13 Journal of the American Medical Association.

The popularity of the treatment has also been fueled by its connection to professional athletes, most notably golfer Tiger Woods, who reported received PRP injections last year to speed his recovery from knee surgery.

The theory behind the practice is that the platelets lead to a release of growth factors that participate in tissue repair.
Action Points
--------------------------------------------------------------------------------

■Explain to interested patients that injections of platelet-rich plasma has become an increasingly popular therapy for chronic tendinopathy, although evidence of benefit has been poor.




■Note that this randomized placebo-controlled trial found no benefit for the procedure.


But support for the theory has been based on laboratory studies and clinical trials that had "important limitations," the researchers said, including lack of a control group or blinding procedure.

To fill the gap, de Vos and colleagues enrolled 54 patients being treated at The Hague Medical Center for chronic tendinopathy two to seven centimeters above the Achilles tendon insertion.

They were randomly assigned to get injections of PRP derived from their own venous blood or a saline placebo, combined with 12 weeks of eccentric exercises. The investigators noted that platelet-rich plasma injections are generally performed now in association with exercise programs.

The primary endpoint was change from baseline to six, 12, and 24 weeks on the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, which evaluates pain score and activity level.

The fluid -- saline or plasma -- was injected through three ultrasound-guided punctures in the tendon. Through each puncture, five small depots of fluid were left in the damaged area of the tendon, the researchers reported.

Based on the questionnaire, both groups improved significantly from baseline through 24 weeks. Those getting plasma improved by 21.7 points, while those getting saline placebo improved by 20.5 points.

There was no significant difference between the groups at 24 weeks or at any other evaluation time point, the researchers found.

The improvement in both groups can probably be attributed to the exercise program, the researchers said, although part of it might be due to a placebo effect among those getting saline.

One limitation of the study, the researchers said, is that the number of platelets and the quantity of growth factors in the injections was not known.

It is also not clear how long such growth factors remained in the tendon; there is a possibility that they might have diffused away rapidly, lessening their effect, the authors noted.

Such limitations mean it's too early to junk the idea entirely, according to Victor Ibrahim, MD, of the National Rehabilitation Hospital in Washington, D.C., who was not part of the study.

It may be, he told MedPage Today, that the exercise component of the study in effect squeezed the active factors out of the tendon. It may also be that the injection protocol, while "reasonable," was not the most effective one, he said.

Patients have begun to regard PRP as a "miracle cure," Ibrahim said, but the study implies that the "foundations of recovery need to be rehabilitation."

"A good therapy program really beats out anything that we have so far when it comes to injections, whether it's steroids or platelet-rich plasma," he said.



-Robert

charliefedererer
01-13-2010, 08:21 AM
Tendonitis, be it tennis or golfer's elbow, patellar tendonitis or any other area, is a poorly classified area that includes multiple causes, different degrees of severity, different lengths of severity, differing degrees of fitness in those afflicted, differing degrees of compliance in recommendations for rest, and often incorporating multiple treatments over time including physical therapy, steroid injections and other manupulations including PRP injections.

In other words "tendonitis" is a mess of diagnoses and treatments.

As a mess, it attracts all sorts of theoretical treatments, with varying degrees of soundness of the theories for treatment.

Tendonitis also invites quackery, with its quicksilver definition and hard to assess outcomes.

Tendonits invites the well intentioned, but biased practitioners to try out new attempts at treating the frustrating inflammatory process of tendonitis.

Tendonitis is avoided by most sensible researchers because of all the impossible to quantify variables.

The body is amazing, and often will heal tendonitis on its own over weeks and months, DESPITE some of the attempted treatments, and poor complience of patients.

Good luck to all those suffering from tendonits.

Smart is the tennis player who works hard to stay in shape, and doesn't keep playing when tendonitis symptoms appear.

It is hard to stop playing tennis and let tendonitis heal if you enjoy the game so much.

charliefedererer
01-13-2010, 08:24 AM
From my knowledge of the inflammatory process of tendonitis, I would have been shocked if PRP therapy were proven effective for most patients.

Does it help some people, would they have gotten better anyway, or would they have improved faster without PRP therapy? Hard to say in any one patient.

drewski711
01-17-2010, 05:31 PM
I actually just reviewed this study for an upcoming sports medicine journal club. Of the two papers I've really sat down and read, both have been very skeptical.
In general, people try to do one of two things for these conditions: 1) Decrease inflammation (steroids, NSAID's) or increase inflammation (PRP, prolotherapy).
Like many of you mentioned, one of the big issues is always trying to figure out what exactly is going on at microscopic level. I think the pathophysiology is very different for acute cases of tendon inflammation vs chronic cases and likely need different treatment strategies.

Robbnc
01-18-2010, 08:43 AM
Well I had it done and IT DOES WORK. I suspect this study was done with
considerable influence from the INSURANCE INDUSRTY who are hell bent on
not paying for the procedure. Studys are a dime a dozen , anybody can buy one. It's fairly well known that most docs at Harvard are owned by the
pharamaceutical industry, no reason to believe they can't be bought by
the insurance crooks too. Do a little research, they pull this stuff all the time.

heres just the first one I pulled up


http://hubpages.com/hub/CROOK-ALERT-Army-Doctor-on-Medtronic-Payroll-Falsified-Study-of-Medtronic-Bone-Repair-Product

Robbnc
01-18-2010, 08:46 AM
scrol down to the article on Harvard Med School Ethics

anything coming out of Harvard is a joke

Robbnc
01-18-2010, 08:52 AM
and just for the record I'm 54 , play at least 4 times a week with an
APDC strung with full poly at 58lbs. It's nearly 2 years since my procedure and
not so much as a twinge. I have no doubt my elbow is not only healed by PRP,
it's much stronger and injury resistant than before the injury.

drewski711
01-19-2010, 12:50 PM
Robbnc,
Have you ever considered your elbow was just going to get better and got better in spite of you getting your injection? This isn't the only study to show that PRP is any better than placebo. If you read the study, some of the people who got PRP did get better (like yourself) but an equal amt got better with a sham injection.

I wish I got paid off by pharmaceutical companies/drug companies as I'd be making a hell of a lot more than I would as a primary care doc. My job is to look at all the evidence and recommend what is best for my patients. Despite what some of the public thinks, a lot of the research that's going on is from physicians who really want to know what is best for their patients and not motivated financial interests. For example, this study was done out of the Netherlands and was FUNDED by the company that provides the technology to do PRP! If you buy into the conspiracy theory, the research should have shown the oppposite result.

El Diablo
01-19-2010, 04:46 PM
Interpreting pharmaceutical research has become confounded by the fact that 80% of research, in the US at least, is now funded by the manufacturers. Thirty years ago it was 20%, most of the rest funded by the government. Pharmaceutical companies usually reserve the right to decide whether a piece of research will be published. So they can commission 20 studies of a drug, have 3 studies show the drug to work and 17 show it not to work, and only allow the 3 positive studies to be published. In the US the government is now having the companies establish websites where they are supposed to put all the data, but they still don't have to publish them all in journals where they will actually be seen.

drewski711
01-19-2010, 07:09 PM
That was actually the most shocking thing about this paper. I just got done reviewing it with some other physicians tonight and we all commented about how refreshing it is to see an industry sponsored study publish negative results. I have to give the company credit for allowing it to be published, especially in one of the big journals.

larry10s
01-20-2010, 06:12 AM
Here's most of it:

Novel Tendon Shots Offered No Benefit over Exercise
By Michael Smith, North American Correspondent, MedPage Today
Published: January 12, 2010
Reviewed by Dori F. Zaleznik, MD; Associate Clinical Professor of Medicine, Harvard Medical School, Boston and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner Earn CME/CE credit
for reading medical news





Copy the code below to embed audio on your website or blog:




An experimental drug-and-exercise therapy for chronic Achilles tendinopathy didn't work in a Dutch study, researchers said.

Injections of platelet-rich plasma (PRP) combined with eccentric exercise gave no better results than exercise alone, according to Robert de Vos, MD, of Erasmus University Medical Center in Rotterdam, and colleagues.

The finding comes from the first randomized, placebo-controlled trial of the therapy, which appears to be gaining popularity on the basis of more limited studies, De Vos and colleagues reported in the Jan. 13 Journal of the American Medical Association.

The popularity of the treatment has also been fueled by its connection to professional athletes, most notably golfer Tiger Woods, who reported received PRP injections last year to speed his recovery from knee surgery.

The theory behind the practice is that the platelets lead to a release of growth factors that participate in tissue repair.
Action Points
--------------------------------------------------------------------------------

■Explain to interested patients that injections of platelet-rich plasma has become an increasingly popular therapy for chronic tendinopathy, although evidence of benefit has been poor.




■Note that this randomized placebo-controlled trial found no benefit for the procedure.


But support for the theory has been based on laboratory studies and clinical trials that had "important limitations," the researchers said, including lack of a control group or blinding procedure.

To fill the gap, de Vos and colleagues enrolled 54 patients being treated at The Hague Medical Center for chronic tendinopathy two to seven centimeters above the Achilles tendon insertion.

They were randomly assigned to get injections of PRP derived from their own venous blood or a saline placebo, combined with 12 weeks of eccentric exercises. The investigators noted that platelet-rich plasma injections are generally performed now in association with exercise programs.

The primary endpoint was change from baseline to six, 12, and 24 weeks on the Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire, which evaluates pain score and activity level.

The fluid -- saline or plasma -- was injected through three ultrasound-guided punctures in the tendon. Through each puncture, five small depots of fluid were left in the damaged area of the tendon, the researchers reported.

Based on the questionnaire, both groups improved significantly from baseline through 24 weeks. Those getting plasma improved by 21.7 points, while those getting saline placebo improved by 20.5 points.

There was no significant difference between the groups at 24 weeks or at any other evaluation time point, the researchers found.

The improvement in both groups can probably be attributed to the exercise program, the researchers said, although part of it might be due to a placebo effect among those getting saline.

One limitation of the study, the researchers said, is that the number of platelets and the quantity of growth factors in the injections was not known.

It is also not clear how long such growth factors remained in the tendon; there is a possibility that they might have diffused away rapidly, lessening their effect, the authors noted.

Such limitations mean it's too early to junk the idea entirely, according to Victor Ibrahim, MD, of the National Rehabilitation Hospital in Washington, D.C., who was not part of the study.

It may be, he told MedPage Today, that the exercise component of the study in effect squeezed the active factors out of the tendon. It may also be that the injection protocol, while "reasonable," was not the most effective one, he said.

Patients have begun to regard PRP as a "miracle cure," Ibrahim said, but the study implies that the "foundations of recovery need to be rehabilitation."

"A good therapy program really beats out anything that we have so far when it comes to injections, whether it's steroids or platelet-rich plasma," he said.



-Robert

robert you always go the extra mile and are on the cutting edge of things. i was big on prp on the few articles i read but now i have to temper my enthusiasm. thanks for the info. larry

larry10s
01-20-2010, 06:13 AM
Smart is the tennis player who works hard to stay in shape, and doesn't keep playing when tendonitis symptoms appear.
.

good advice

Robbnc
02-22-2010, 11:00 AM
So much for your crackpot study!



http://sarasotaneurology.com/2010/01/15/jama-reports-prp-not-effective-a-poorly-designed-study/

Robbnc
02-22-2010, 11:32 AM
And, I just called my docs office, thrombin WAS used in my injections.

The folks in the bogus study just didn't know what the hell they were doing.