Platelet-Rich Plasma May Have Edge in Jumper’s Knee

Written by admin on May 31, 2013 – 11:07 pm -

Reuters Health Information
Platelet-Rich Plasma May Have Edge in Jumper’s Knee
Mar 07, 2013

By David Douglas
NEW YORK (Reuters Health) Mar 07 – Platelet-rich plasma (PRP) injections might be more helpful to athletes with jumper’s knee than focused extracorporeal shock wave therapy (ESWT), according to Italian researchers.
Dr. Mario Vetrano told Reuters Health by email that both approaches “seem to be safe and promising as part of the treatment of jumper’s knee patients. However, both treatments share the same disputes: lack of hard evidence through randomized clinical trials and no standardized treatment protocols.”
To compare outcomes, Dr. Vetrano and colleagues at Sapienza University of Rome studied 46 athletes with tendonopathy due to overuse of the knee extensor mechanism.
They randomized their patients to receive either two autologous PRP injections over two weeks under ultrasound guidance, or three sessions of focused ESWT. Both groups then went on to a standardized stretching and muscle strengthening protocol.
Given minimal or no pain after four weeks, patients were allowed to gradually return to previous training activity. Complete return to sports took place in accordance with the patient’s pain tolerance and recovery.
A blinded reviewer made assessments before and up to 12 months after treatment. The findings were published online February 13th in The American Journal of Sports Medicine.
Both groups showed benefit, and there were no significant between-group differences in outcome measures at two months. No clinically relevant side effects were seen in either group.
However, at six and 12 months, the PRP group showed significantly greater improvement in Victorian Institute of Sports Assessment-Patella questionnaire and pain visual analogue scale. At 12 months, the PRP group also had significantly better modified Blazina scale scores.
Both approaches seem promising, but “given current knowledge,” say the investigators, “it is impossible to recommend a specific treatment protocol.”
Nevertheless, as Dr. Vetrano concluded, “The analysis of our study showed comparable results in both treatment groups at short term, with better results in the PRP group at six and 12 month follow-ups.”
SOURCE: http://bit.ly/Zu8fCl
Am J Sports Med 2013.


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“Platelet-Rich Plasma May Have Edge in Jumper’s Knee”

Written by admin on March 14, 2013 – 6:55 am -

By David Douglas: NEW YORK (Reuters Health) Mar 07

Platelet-rich plasma (PRP) injections might be more helpful to athletes with jumper’s knee than focused extracorporeal shock wave therapy (ESWT), according to Italian researchers.

Dr. Mario Vetrano told Reuters Health by email that both approaches “seem to be safe and promising as part of the treatment of jumper’s knee patients. However, both treatments share the same disputes: lack of hard evidence through randomized clinical trials and no standardized treatment protocols.”

To compare outcomes, Dr. Vetrano and colleagues at Sapienza University of Rome studied 46 athletes with tendonopathy due to overuse of the knee extensor mechanism.

They randomized their patients to receive either two autologous PRP injections over two weeks under ultrasound guidance, or three sessions of focused ESWT. Both groups then went on to a standardized stretching and muscle strengthening protocol.

Given minimal or no pain after four weeks, patients were allowed to gradually return to previous training activity. Complete return to sports took place in accordance with the patient’s pain tolerance and recovery.

A blinded reviewer made assessments before and up to 12 months after treatment. The findings were published online February 13th in The American Journal of Sports Medicine.

Both groups showed benefit, and there were no significant between-group differences in outcome measures at two months. No clinically relevant side effects were seen in either group.

However, at six and 12 months, the PRP group showed significantly greater improvement in Victorian Institute of Sports Assessment-Patella questionnaire and pain visual analogue scale. At 12 months, the PRP group also had significantly better modified Blazina scale scores.

Both approaches seem promising, but “given current knowledge,” say the investigators, “it is impossible to recommend a specific treatment protocol.”

Nevertheless, as Dr. Vetrano concluded, “The analysis of our study showed comparable results in both treatment groups at short term, with better results in the PRP group at six and 12 month follow-ups.”

Original Study Published in American Journal of Sports Medicine by Mario Vetrano, MD, Anna Castorina, MD, Maria Chiara Vulpiani, MD, Rossella Baldini, PhD, Antonio Pavan, MD, and Andrea Ferretti, MD.

Abstract available

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For more information on Platelet-Rich Plasma (PRP) therapy, please read my article at www.orthonc.com.


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Rotator Cuff Tears

Written by admin on January 22, 2013 – 8:24 am -

Your shoulder hurts, but you cannot remember an injury. You are unsure of exactly when and how it began. It wakes you every night and may hurt with many routine daily activities. Sports are no longer possible. Huh?! What happened?

If you’re over the age of 40, your rotator cuff may be beginning to fail, causing discomfort and diminished function. The incidence of rotator cuff tears increases with age, and a specific injury is not required. The rotator cuff is comprised of four small muscles, the supraspinatus, infraspinatus, subscapularis and teres minor. These muscles are responsible for proper motion and stability of the shoulder joint.

Aging and repetitive use often results in weakening of the tendon which detaches from insertion point on the humerus. The process occurs in much in the same way as a blanket becomes threadbare or a rope begins to fray. Over head athletes and those of us with jobs requiring repetitive overhead motion are more susceptible to rotator cuff pathologies.

Symptoms of rotator cuff insufficiency include: achy pain at rest and particularly at night, pain with over head motion or reaching behind the body. Progressively worsening and more frequent pain is also a typical progression of rotator cuff pathology. An orthopedic surgeon specializing in shoulder conditions can help accurately diagnose a rotator cuff tear and initiate appropriate treatment. On occasion more extensive testing such as ultrasound or MRI may be required to better evaluate the condition of the rotator cuff tendons. Results of these examinations will help to determine the most appropriate treatment.

Recommendations may include activity modification (avoid activities that cause pain), physical therapy with elastic bands to strengthen the muscles, oral or topical anti-inflammatory medication, and steroid injections in the shoulder. This treatment will not necessarily reverse the damage, but rather will improve function of the muscles to lessen the daily wear on the remaining tendons, if successful, some healing of the damaged tendons may occur.

If symptoms persist after six weeks of diligent rehab and compliance with conservative treatment plan, more aggressive treatment, such as surgery, may be required. The surgical technique is intended to remove any damaged tendon that lacks adequate blood supply (and thus, is unable to heal) and to repair the viable, healthy tendon attaching it back to the bone. The procedure is arthroscopic (2-4 small incisions), outpatient, and usually performed without the need for general anesthesia. Return to daily living activities usually requires 2-6 weeks. Full recovery can be long and arduous, but excellent results are achieved more than 80% of the time.

Shoulder pain is never something to ignore, and should be evaluated by an orthopedic shoulder specialist to insure the proper course of treatment.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com or you can follow him on twitter: @drmarkgalland.

Kate Anderson, LAT, ATC is a post-graduate fellow at GOSM, Galland Orthopaedic and Sports Medicine. Follow her on twitter @kattethegreatt.


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What is Plantar Fasciitis?

Written by admin on January 16, 2013 – 7:02 am -

Plantar fasciitis is the progressive degeneration of the plantar fascia of the foot and is a common Orthopaedic complaint. . Plantar fascia is the medical term for the fibrous connective tissue that comprises and creates the arch of the foot by connecting the calcaneus (heel bone) to each of the phalanges (toes). The plantar fascia is located along the bottom side (plantar surface) of the foot, and is amongst the densest fascia in the body. Originally presumed to be an inflammatory disorder of this tissue, we now know that inflammation is only rarely the culprit. Numerous men, women, and even world-class athletes suffer from plantar fasciitis. Marcus Camby of the New York Knicks and Derrick Favors of the Utah Jazz are two NBA players currently battling the condition.

Plantar fasciitis is most prevalent in men between the ages of forty and seventy but is also frequently seen in women. The most common complaint of plantar fasciitis is a sharp pain in the heel or arch of the foot. Others include a ‘pulling’ sensation, a sharp or dull ache, or a burning sensation. Someone suffering from plantar fasciitis may complain of pain during or after intense exercise, or after standing for long periods of time; however, the classic report is pain in the morning when getting out of bed but subsiding throughout the day, or a gradual onset of dull pain which then turns into sharp pain as the day progresses. Individuals with pes planus (flat feet/no arch) or pes cavus (very high arch) are more prone to plantar fasciitis (albeit for different reasons) than individuals with normal arches. Other causes or risk factors for plantar fasciitis are sudden weight gain or obesity, long distance running, and poor arch support in shoes.

Initial treatment begins with rest, ice massage (freezing a water bottle and rolling the bottle back and forth under the foot), OTC anti-inflammatories, and stretching the foot and heel throughout the day–especially before getting out of bed– by rolling over a tennis ball, wearing shoes with the appropriate amount of support, shoe inserts, and wearing night splints while sleeping to keep the foot and fascia stretched throughout the night, preventing contraction (tightening) of the fascia tissue. If conservative treatment fails, PRP or steroid injections and/or surgery may be considered. We have had excellent results with the emerging technique of Platelet Rich Plasma (PRP) injections.

Plantar fasciitis symptoms may take anywhere from days to years to subside. Prevention of plantar fasciitis is best ensured by optimizing the flexibility of the ankle joint, Achilles tendon, and calf muscles (gastrocnemius and soleus)

References

A.D.A.M. Medical Encyclopedia. (2012, March 1). Plantar fasciitis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004438/

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com.

Caitlin Davis, LAT, ATC is a post graduate fellow at GOSM. For more information, visit us at www.atcfellowship.com


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“Injections for tennis elbow: Sometimes they work, sometimes they don’t.”

Written by admin on January 9, 2013 – 8:45 am -

NEW YORK (Reuters Health) Sep 27 – Among the variety of injections that have been tested for lateral epicondylitis – tennis elbow – it remains unclear which ones work and which ones don’t, a new systematic review concludes.

Tennis elbow affects 1% to 3% of the population and peaks between the ages of 45 and 54 years. Injection therapies have included glucocorticoids, platelet-rich plasma (PRP), autologous blood, prolotherapy, hyaluronic acid, botulinum toxin, polidocanol, and glycosaminoglycan polysulfate.

In an effort to determine which injection therapies work best, Dr. Robin Christensen from Copenhagen University Hospital, Frederiksberg, Denmark and colleagues conducted a systematic review of 17 randomized controlled trials that evaluated eight different injection therapies in 1,381 patients.

They considered only two outcomes: change in pain intensity and adverse events (including the number of adverse events leading to withdrawal).

Glucocorticoid, polidocanol, and glycosaminoglycan polysulfate proved to be no better than placebo in relieving pain of tennis elbow, according to the report online September 12 in the American Journal of Sports Medicine.

Botulinum toxin was marginally effective compared with placebo but was associated with significant side effects (transient paresis and weakness). Moreover, all trials of botulinum toxin had high or unclear risk of bias.

Autologous blood, PRP, prolotherapy, and hyaluronic acid were all significantly more effective than placebo, but only prolotherapy was significantly better than placebo after excluding results from trials with high or unclear bias.

Transient pain after injection was common in all the trials, but there were no withdrawals due to adverse events and no serious adverse events.

Overall, only three of the trials (18%) were judged to be low risk of bias.

The researchers conclude, “Our systematic review and network meta-analysis found a paucity of evidence from unbiased trials on which to base treatment recommendations regarding injection therapies for lateral epicondylitis.”

“Further high-quality trials are needed and should have an adequate sample size, valid inclusion criteria, including confirmation of the diagnosis with imaging, and valid and reliable patient-relevant outcome measures,” they add.


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I don’t play tennis, how do I have “tennis elbow”?

Written by admin on January 7, 2013 – 8:52 am -

You don’t have to be Serena Williams or Roger Federer to be diagnosed with “tennis elbow”. You may be surprised to learn that most of my patients with this condition have never played tennis, even once! Tennis elbow, or lateral epicondylitis, is the progressive degeneration of the tendons that attach the forearm muscles to the outside of the elbow.

Originally presumed to be an inflammatory condition, “tendonitis,” it is now well accepted that true tendonitis is only rarely present. The term “tennis elbow” originates in the high prevalence of the malady in tennis players. Players experience pain when grasping the racquet with backhand strokes being most problematic, but any grasping activity, even non-athletic, may be associated with pain. Primarily an overuse injury, racquet sports athletes, as well as painters, carpenters, and mechanics, are prone to developing tennis elbow.

Symptoms of tennis elbow include pain localized on the outside of the elbow, weak grip strength, and pain with specific motions (picking up a gallon of milk, turning a door knob, or holding a cup of coffee).

There are surgical and non surgical treatment options for tennis elbow. Non surgical options include: oral or topical anti-inflammatory medication, braces designed to change the angle of action of the tendon, lessen pressure at its boney insertion and decrease pain, exercises to stretch and strengthen the muscles and steroid injections directly into the tendon. Initially, rest, particularly avoiding those motions that cause the most pain are ideal. Once symptoms subside, stretching and strengthening the elbow will help prevent further damage to the tendon. We have recently enjoyed success with a promising emerging technique, Platelet Rich Plasma (PRP), injections directly into the failing tendon. Surgical treatment is an outpatient procedure in which the surgeon removes the defective tendon. The recovery time from surgery is a few weeks before normal subsistence level activities can be performed painlessly and 10-12 weeks before sport and weight activities can be resumed.

Dr. Mark Galland is a Board Certified Orthopaedic Surgeon specializing in sports medicine, practicing in Wake Forest and North Raleigh. He serves as team physician and Orthopaedic consultant to the Carolina Mudcats, High-A Affiliate of the Cleveland Indians of Major League Baseball, as well as several area high schools and colleges. Dr. Galland can be reached at (919) 562-9410 or by visiting www.orthonc.com or www.drmarkgalland.com or you can follow him on twitter: @drmarkgalland.

Kate Anderson, ATC/LAT is a post-graduate fellow at GOSM, Galland Orthopaedic and Sports Medicine. Follow her on twitter @kattethegreatt.


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Optimal Hamstring Treatment Still a Mystery

Written by admin on December 26, 2012 – 9:12 am -

“Despite the high rate of hamstring injuries, there is no consensus on their management, with a large number of different interventions being used. Recently several new injection therapies have been introduced.”

Hamstring Article


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PRP May Be Superior Knee OA Treatment When Compared With Visco Supplementation

Written by admin on December 6, 2012 – 8:18 pm -

Comparison Between Hyaluronic Acid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis.

Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M.


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Dr. Mark Galland Releases Podcast On Platelet Rich Plasma Therapy

Written by admin on October 12, 2012 – 8:55 am -

Dr. Mark Galland, a physician at Orthopaedic Specialists of North Carolina, has announced the release of a podcast discussing platelet rich plasma therapy, a minimally invasive, non-operative method of treating common overuse in chronic musculoskeletal injuries. In the podcast, Galland discusses what the therapy treatment entails, what types of injuries it treats, candidates for the therapy and the recovery process after the treatment.

“It is important for people, especially athletes, to be aware of platelet rich plasma therapy and what it can do for treating an injury,” said Galland. “It is an alternative, non-surgical treatment for athletes and non-athletes to improve joint and tendon injuries that could affect their daily lives.”

To listen to the podcast, click here: PRP Therapy.


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