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Platelet rich plasma: The scientific evidence

Platelet rich plasma: The scientific evidence

Feb 17, 2024

We have already had a look at how platelet rich plasma (PRP) works (if you haven’t had a chance to read this yet, you can find it here), but now we are going to dive more deeply into the scientific evidence behind this treatment.
Randomised controlled trials (RCTs) are the gold standard study for determining if one treatment offers superior benefits over another. In these trials, patients are randomly assigned to either receive the treatment of interest or an alternative treatment, usually the standard of care or a placebo. Moreover, the patients are ‘blind’ to what treatment they are receiving. Here, we are going to look at two RCTs that investigated the use of PRP to treat knee osteoarthritis and chronic tennis elbow.

Knee osteoarthritis

A study by Bansal et al. (2021) investigated the optimal dose and concentration of therapeutic PRP required to achieve the desired physiologic efficacy. One hundred and fifty patients were enrolled in this trial, with then being randomised to either receive PRP or hyaluronic acid for their knee osteoarthritis.
The results revealed a significant improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), International Knee Documentation Committee (IKDC) score*, and six-minute pain free walking distance. Besides external improvements, this trial also noted a significant decline in IL-6 and TNF-a levels in the PRP group when compared to the hyaluronic acid group at six months, both of which assist in mediating an inflammatory state (Bansal et al., 2021). If you would like to read more about the role of these cytokines in osteoarthritis, we have an additional blog post discussing just that.
Collectively, this trial, along with several others, demonstrate the efficacy of PRP, specifically with an absolute count of ten billion platelets, in achieving a long sustained chondroprotective effective in arthritis.
*The WOMAC represents an osteoarthritis index and measures a patients’ physical function, pain, and stiffness over a 48 hour period. The IKDC, on the other hand, gives an indication of a patients’ condition, containing questions on knee symptoms, overall function, and sports activities. The scoring system ranges from zero to one hundred, with zero representing the lowest level of function and the highest level of symptoms.

Chronic tennis elbow

A study by Mishra et al. (2014) evaluated the clinical value of tendon needling with PRP in 230 patients with chronic tennis elbow compared with an active control group. Patient outcomes were followed for up to 24 weeks, with the findings revealing several beneficial results at this mark. In those treated with PRP, a significant improvement of 71.5% was observed in their pain scores. Moreover, the percentage of patients reporting significant elbow tenderness notably decreased over this time. This demonstrates the clinical efficacy of PRP in the treatment of chronic tennis elbow on a larger scale (Mishra et al., 2014).

References

Bansal, H., Leon, J., Pont, J. L., Wilson, D. A., Bansal, A., Agarwal, D. & Preoteasa, I. 2021. Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy. Scientific Reports, 11, 3971. Mishra, A. K., Skrepnik, N. V., Edwards, S. G., Jones, G. L., Sampson, S., Vermillion, D. A., Ramsey, M. L., Karli, D. C. & Rettig, A. C. 2014. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med, 42, 463-71.
Platelet rich plasma injections for tendonitis

Platelet rich plasma injections for tendonitis

Feb 17, 2024

Platelet rich plasma treatment(PRP)
represents a promising approach to therapy for a range of conditions, including torn tendons, arthritis, muscle injuries, and tendonitis. We have already looked at the process of PRP and the underlying scientific evidence in our previous posts. Now, we are going to look specifically at the use of PRP in the treatment of tendonitis. But first, what is tendonitis, and how does it affect a person?

Tendonitis is a term used to define inflammation and pain following a tendon injury. This usually causes significant pain, stiffness and alters how the tendon can move. The most common areas that are affected by tendonitis are the rotator cuff, the elbow, and the Achilles tendon, with an overall prevalence of an estimated 11.6% in the general population. Although most cases of tendonitis resolve themselves within two to three weeks with relative rest of the area, icing, and strengthening exercises, a number of cases require medical intervention if they persist.

PRP therapy for tendonitis generally involves three injections, given at two to three week intervals; however, in certain cases, further injections may be needed to complete your journey. But do not worry; our doctors at Opus will discuss this and the treatment protocol with you throughout the process. The procedure itself follows three stages:

    1. The plasma, the liquid where the platelets reside, is drawn from your body through the blood.
    2. This is then placed in a machine to separate the PRP from the rest of your blood.
    3. The PRP is then injected into the area where you are experiencing tendonitis.

    Once the platelets are in the target area, they will break down, releasing growth factors. These growth factors are the pivotal component of PRP and are the reason that this treatment has shown great promise in conditions such as tendonitis. Growth factors are important proteins that stimulate cell growth, differentiation, survival, inflammation, and tissue repair; collectively, triggering your body’s healing process. Specifically, in the treatment of tendonitis, growth factors play an important role in the tendon healing process. Not only are they directly involved in tendon tissue engineering, but they have also been shown to stimulate the action of mesenchymal stem cells. To understand the role of these stem cells in regenerative medicine, we discuss them in more detail here.

    If you or someone you know are suffering from tendonitis, book an appointment today to speak to one of our team at Opus on the next steps to reduce your pain and improve your everyday function.

    Injury Prevention for Skiing

    Injury Prevention for Skiing

    Jan 31, 2024

    There are many risk factors that could cause injury when skiing which include equipment, technique, experience, education, awareness and snow related injuries (Hebert-Losier and Holmberg,2016). Research has shown that ski equipment (highly shaped, short and wide skis) has the most impact when preventing injuries (Spörri et. Al, 2017). Nevertheless, it is important to ensure professional and amateur skiers meet the physical demands of skiing to further reduce the risk of injury; this can be achieved through endurance training and strength and conditioning (Hebert-Losier and Holmberg,2016).

    Sport specific strength training is key for improving technique and delay in muscle fatigue (Sandbakk, 2018). In order to formulate a ski specific strength programme, it is important to understand the most common injuries caused by skiing.  Spörri et. all established 80% of injuries occur while the skier is turning and 19% when landing. Upper limb injuries are caused by crashes (96%) and knee injuries are the most common in skiing (83%). Hewett et. al used a screening method to assess the valgus loading of the knee to predict the risk of ACL injuries. The athletes who sustained ACL injury had a higher valgus angle compared to the uninjured athletes (Spörri et. al 2017).  In order to reduce the valgus angle in the knee, it is important to focus on strengthening hip abductors, hip external rotators (Dix et. al 2019) and quadriceps to support the knee within the sagittal plane when skiing (Morrissey et. Al 1987). Additionally, recent studies have shown the importance of core strengthening exercises in preventing ACL injuries in alpine skiing. Raschner et. all found athletes with reduced core strength or core strength imbalance had an increased risk for an ACL injury (Spörri et. Al, 2017). Therefore, a strength training programme focusing on core and lower limb strengthening is key to reducing the risk of injury in skiers.

    Endurance training for alpine skiing is crucial for performance (Neumayr et. Al 2003) and in reducing the risk of fatigue. The traditional recommendation for cardiovascular endurance training is a minimum of 20 minutes within 70%-80% of maximum heart rate (Morrissey et. Al 1987). However more recent research has shown high intensity interval training (HIIT) is also an effective method of improving endurance for skiers. Sandbakk et. al found aerobic HIIT improves endurance and ‘oxygen uptake at the ventilatory threshold’ (Sandbakk et. al 2013) in junior cross-country skiers. Furthermore, active on-hill recovery within training has shown to ‘optimize blood lactate clearance’(Spörri et. al 2017) and ‘increase run completion rate’ (Spörri et. al 2017) therefore highlighting the importance of endurance training in the prevention of injury.

    Neuromuscular training for skiers is key to preventing falls. Jacopo et. al established that including a neuromuscular warm- up programme for skiers had a positive impact on dynamic balance by improving their lower limb awareness and control (Jacobi et. al 2018). However recent studies show neuromuscular training programs reduce the risk of ACL injuries apart from alpine ski racing. This is likely due to ski boots further challenging the athletes’ balance (Spörri et. al 2017).

    Reference List

     

    • Dix, J., Marsh, S., Dingenen, B. and Malliaras, P. (2018). The relationship between hip muscle strength and dynamic knee valgus in asymptomatic females: A systematic review. Physical Therapy in Sport, 37. doi:https://doi.org/10.1016/j.ptsp.2018.05.015.

    • Hébert-Losier, K. and Holmberg, H.-C. (2013). What are the Exercise-Based Injury Prevention Recommendations for Recreational Alpine Skiing and Snowboarding? Sports Medicine, 43(5), pp.355–366. doi:https://doi.org/10.1007/s40279-013-0032-2.

    • Morrissey, M.C., Seto, J.L., Brewster, C.E. and Kerlan, R.K. (1987). Conditioning for Skiing and Ski Injury Prevention. Journal of Orthopaedic & Sports Physical Therapy, 8(9), pp.428–437. doi:https://doi.org/10.2519/jospt.1987.8.9.428.

    • Neumayr, G., Hoertnagl, H., Pfister, R., Koller, A., Eibl, G. and Raas, E. (2003). Physical and Physiological Factors Associated with Success in Professional Alpine Skiing. International Journal of Sports Medicine, 24(8), pp.571–575. doi:https://doi.org/10.1055/s-2003-43270.

    • Sandbakk, Ø. (2018). PRACTICAL IMPLEMENTATION OF STRENGTH TRAINING TO IMPROVE THE PERFORMANCE OF WORLD-CLASS CROSS-COUNTRY SKIERS. Kinesiology, [online] 50(1), pp.155–162. Available at: https://hrcak.srce.hr/ojs/index.php/kinesiology/article/view/6420 [Accessed 26 Jan. 2024].

    • Sandbakk, Ø., Sandbakk, S.B., Ettema, G. and Welde, B. (2013). Effects of Intensity and Duration in Aerobic High-Intensity Interval Training in Highly Trained Junior Cross-Country Skiers. Journal of Strength and Conditioning Research, 27(7), pp.1974–1980. doi:https://doi.org/10.1519/jsc.0b013e3182752f08.

    • Spörri, J., Kröll, J., Gilgien, M. and Müller, E. (2016). How to Prevent Injuries in Alpine Ski Racing: What Do We Know and Where Do We Go from Here? Sports Medicine, [online] 47(4), pp.599–614. doi:https://doi.org/10.1007/s40279-016-0601-2.

    • Vitale, J.A., La Torre, A., Banfi, G. and Bonato, M. (2018). Effects of an 8-Week Body-Weight Neuromuscular Training on Dynamic Balance and Vertical Jump Performances in Elite Junior Skiing Athletes. Journal of Strength and Conditioning Research, 32(4), pp.911–920. doi:https://doi.org/10.1519/jsc.0000000000002478.

    • White, G.E. and Wells, G.D. (2015). The Effect of On-Hill Active Recovery Performed Between Runs on Blood Lactate Concentration and Fatigue in Alpine Ski Racers. Journal of Strength and Conditioning Research, 29(3), pp.800–806. doi:https://doi.org/10.1519/jsc.0000000000000677.

    Antibodies and the Immune System

    Antibodies and the Immune System

    Dec 20, 2023

    Photo by Artem Podrez from Pexels

    We have already looked at the role of antibody testing in the fight against COVID-19; however, there was just too much information to discuss in one post. Therefore, this post is aimed at diving into a bit more detail on antibody testing for SARS-CoV-2 and looking at misconceptions surrounding this.

    When taking an antibody test, we are looking for anti-SARS-CoV-2 antibodies, which can be found in your blood as early as ten days after experiencing COVID-19 symptoms. Therefore, not only is antibody testing useful on its own, when combined with PCR testing, these detection methods minimise the likelihood of receiving a false-negative test. Moreover, antibody tests for SARS-CoV-2 are based primarily on the detection of antibodies against specific proteins. But, what does this mean? The novel coronavirus has four main structural proteins, the nucleocapsid (N), the spike (S), the membrane (M), and the envelope (E), as seen in the image below. However, antibody testing solely focuses on the detection of the S protein, consisting of S1 and S2 subunits, and the N protein, as these are the main immunogens of this virus.

    The S protein of SARS-CoV-2 is located on the surface of the virus and is highly immunogenic. Each subunit of this protein plays a different role, with the S1 protein containing the receptor binding domain, a key target of neutralising antibodies. The N protein, on the other hand, plays a crucial role in the replication of viral RNA, enabling the virus to survive in our system. Its role in transcription enables the virus’s genome to be packaged into virions and also inhibits the cell cycle process of our cells. During infections, the N protein is vastly expressed and possesses high immunogenic activity.

    Image taken from: https://www.invivogen.com/covid-19-related-genes

    Although antibody testing is focused on detecting antibodies against either the S or N protein of SARS-CoV-2, it has been recommended that a testing method that detects antibodies against both proteins be used to gain the most accurate results. This method has been adopted across the UK, and the antibody testing at Opus is no exception to this.

    COVID-19: Same-Day Fit to Fly Testing

    COVID-19: Same-Day Fit to Fly Testing

    Dec 20, 2023

    Photo by Alex Koch from Pexels

    Rapid antigen testing, also more commonly known as lateral flow testing, is a faster method of COVID-19 detection than PCR testing. Rapid antigen tests have a specificity of over 97% and have been widely adopted across the UK as a measure of controlling the COVID-19 pandemic.

    These easy-to-use tests can either be done at a local test site, a healthcare provider, such as Opus Biological, or from the comfort of your own home. The tests themselves will either require a throat or a nasal swab, with our staff providing you with the instructions on which is needed. This will be done at your short medical consultation prior to the test, carried out either in person or via video consultation.

    Although lateral flow tests have been largely discussed for regular COVID-19 testing in the UK, they are now being used under the Government travel guidance for those travelling to England. 

    You will need to take a COVID-19 test before arriving in the UK if you either do not qualify as fully vaccinated or you have been in a country or territory on the red list in the ten days before you arrive in England. A full list of the red list countries and territories can be found here, whilst the Travel to England guidance to find out if you qualify as fully vaccinated can be found here.

    This use of lateral flow tests has been termed fit to fly testing, and it does what it says on the tin, ensuring you are not carrying the COVID-19 virus before you begin your travels or return to the UK. Whether you are jetting off somewhere warm or you are simply flying with the UK, a lateral flow test offers you the freedom to do so. It is, however, important to remember that these tests must be ordered and performed through a private provider and booked in advance before your trip.

    How to get your Fit to Fly test Private testing for this scheme is available at several pharmacies up and down the country. At Opus, our tests are undertaken in a UKAS accredited partner laboratory and are CE marked, ensuring you receive the most accurate results. The Fit to Fly test itself will tell you if you are infected when taking your sample, with this information being relayed to you within 24 hours of the sample reaching our labs. We also offer same day access to testing for both the COVID-19 virus and for COVID-19 antibodies, easing your mind when it comes to last minute trips.

    Going abroad and want to book your Fit to Fly test at Opus? Get in touch with us now.