“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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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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