scholarly journals Influence of platelet-rich plasma (PRP) analogues on healing and clinical outcomes following anterior cruciate ligament (ACL) reconstructive surgery: a systematic review

2022 ◽  
Author(s):  
Jonathon McRobb ◽  
Khawaja Hasan Kamil ◽  
Imran Ahmed ◽  
Fatema Dhaif ◽  
Andrew Metcalfe
Keyword(s):  
Clinical Outcomes ◽  
Narrative Analysis ◽  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Healing Process ◽  
Knee Function ◽  
Long Term Effects ◽  
Diverse Range ◽  
The Impact

Abstract Purpose To systematically review the effect of PRP on healing (vascularization, inflammation and ligamentization) and clinical outcomes (pain, knee function and stability) in patients undergoing ACL reconstruction and compare the preparation and application of PRP. Methods Independent systematic searches of online databases (Medline, Embase and Web of Science) were conducted following PRISMA guidelines (final search 10th July 2021). Studies were screened against inclusion criteria and risk of bias assessed using Critical appraisal skills programme (CASP) Randomised controlled trial (RCT) checklist. Independent data extraction preceded narrative analysis. Results 13 RCTs were included. The methods of PRP collection and application were varied. Significant early increases in rate of ligamentization and vascularisation were observed alongside early decreases in inflammation. No significant results were achieved in the later stages of the healing process. Significantly improved pain and knee function was found but no consensus reached. Conclusions PRP influences healing through early vascularisation, culminating in higher rates of ligamentization. Long-term effects were not demonstrated suggesting the influence of PRP is limited. No consensus was reached on the impact of PRP on pain, knee stability and resultant knee function, providing avenues for further research. Subsequent investigations could incorporate multiple doses over time, more frequent observation and comparisons of different forms of PRP. The lack of standardisation of PRP collection and application techniques makes comparison difficult. Due to considerable heterogeneity, (I2 > 50%), a formal meta-analysis was not possible highlighting the need for further high quality RCTs to assess the effectiveness of PRP. The biasing towards young males highlights the need for a more diverse range of participants to make the study more applicable to the general population. Trail registration CRD42021242078CRD, 15th March 2021, retrospectively registered.

The Learning Curve in Arthroscopic ACL Reconstruction. The impact on the Surgical Time and Postoperative Clinical Results

2018 ◽  
Vol 69 (10) ◽  
pp. 2874-2876
Author(s):  
Teodor Negru ◽  
Stefan Mogos ◽  
Ioan Cristian Stoica
Keyword(s):  
Anterior Cruciate Ligament ◽  
Learning Curve ◽  
Clinical Outcomes ◽  
Positive Impact ◽  
Cruciate Ligament ◽  
Clinical Results ◽  
Single Bundle ◽  
Surgical Time ◽  
Anterior Cruciate ◽  
The Impact

Rupture of the anterior cruciate ligament (ACL) is a common injury. The objective of the current study was to evaluate if the learning curve has an impact on surgical time and postoperative clinical outcomes after anatomic single-bundle anterior cruciate ligament reconstruction (ACLR) using an outside-in tunnel drilling hamstrings technique. The learning curve has a positive impact on surgical time but has no influence on postoperative clinical outcomes at short time follow-up.

Posterior Cruciate Ligament Reconstruction With Transtibial or Tibial Inlay Techniques: A Meta-analysis of Biomechanical and Clinical Outcomes

2018 ◽  
Vol 46 (11) ◽  
pp. 2789-2797 ◽  
Author(s):  
Dong-Yeong Lee ◽  
Dong-Hee Kim ◽  
Hyun-Jung Kim ◽  
Hyeong-Sik Ahn ◽  
Tae-Ho Lee ◽  
...  
Keyword(s):  
Posterior Cruciate Ligament ◽  
Clinical Outcomes ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Meta Analysis ◽  
Knee Function ◽  
Controlled Trials ◽  
Posterior Cruciate Ligament Reconstruction ◽  
Cruciate Ligament Reconstruction ◽  
Tibial Inlay

Background: Transtibial (TT) or tibial inlay (TI) techniques are commonly used for posterior cruciate ligament reconstruction (PCLR). However, the optimum method for PCLR after PCL injury remains debatable. Hypothesis/Purpose: The hypothesis was that TT and TI techniques would not show significant differences for all outcome measures. The purpose was to determine the biomechanical and clinical outcomes of TT and TI surgical techniques for PCLR. Study Design: Meta-analysis; Level of evidence, 3. Methods: MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and SCOPUS electronic databases for articles published up until August 2016 were searched to find relevant articles comparing outcomes of TT versus TI techniques for PCLR. Data searching, extraction, analysis, and quality assessment were performed according to Cochrane Collaboration guidelines. Biomechanical outcomes and clinical outcomes of both techniques were compared. Results are presented as risk ratio (RR) for binary outcomes and weighted mean difference (WMD) for continuous outcomes with 95% confidence intervals (CI). Results: Five biomechanical and 5 clinical studies were included. No significant biomechanical differences were found regarding posterior tibial translation (PTT) at a knee flexion angle of 90° or PTT after cyclic loading between the 2 groups. However, a stronger in situ force in the graft was detected in the TT group (WMD = 15.58; 95% CI, 0.22-30.95; I2 = 10%). Although no significant differences were found in clinical outcomes such as Lysholm knee function score, Tegner activity score, side-to-side difference, or posterior drawer test at final follow-up between the 2 groups, the TT technique tended to entail fewer perioperative complications than the TI technique (RR = 0.60; 95% CI, 0.35-1.00; I2 = 0%). Conclusion: TT and TI techniques for PCLR can both restore normal knee kinematics and improve knee function. However, the issue of which yields better improvement in stability and functional recovery of the knee remains unclear. More high-quality trials and randomized controlled trials are needed. Although PCLR via the TT technique resulted in higher graft forces, determining whether this is clinically significant will require further studies. When performing the TI technique, surgeons should inform patients of the risk of complications.

Loss of patellofemoral cartilage thickness over 5 years following ACL injury depends on the initial treatment strategy: results from the KANON trial

2019 ◽  
Vol 53 (18) ◽  
pp. 1168-1173 ◽  
Author(s):  
Adam G Culvenor ◽  
Felix Eckstein ◽  
Wolfgang Wirth ◽  
L Stefan Lohmander ◽  
Richard Frobell
Keyword(s):  
Treatment Strategy ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Cartilage Thickness ◽  
Acl Rupture ◽  
Thickness Loss ◽  
Patellar Cartilage ◽  
Randomised Controlled ◽  
The Impact

ObjectivesTo evaluate changes in patellofemoral cartilage thickness over 5 years after anterior cruciate ligament (ACL) injury and to determine the impact of treatment strategy.Methods121 adults (ages 18–35 years, 26% women) had an ACL injury and participated in the KANON randomised controlled trial. Of those, 117 had available MRIs at baseline (<4 weeks post-ACL rupture) and at least one follow-up measurement (2, 5 years). Patellofemoral cartilage thickness was analysed by manual segmentation (blinded to acquisition order). Patellar, trochlear and total patellofemoral cartilage thickness changes were compared between as-randomised (rehabilitation+early ACL reconstruction (ACLR) (n=59) vs rehabilitation+optional delayed ACLR (n=58)) and as-treated groups (rehabilitation+early ACLR (n=59) vs rehabilitation +delayed ACLR (n=29) vs rehabilitation alone (n=29)).ResultsPatellofemoral cartilage thickness decreased −58 µm (95% CI −104 to –11 µm) over 5 years post-ACL rupture, with the greatest loss observed in trochlea during the first 2 years. Participants randomised to rehabilitation+early ACLR had significantly greater loss of patellar cartilage thickness compared with participants randomised to rehabilitation+optional delayed ACLR over the first 2 years (−25 µm (−52, 1 µm) vs +14 µm (−6 to 34 µm), p=0.02) as well as over 5 years (−36 µm (−78 to 5 µm) vs +18 µm (−7, 42 µm), p=0.02). There were no statistically significant differences in patellofemoral cartilage thickness changes between as-treated groups.ConclusionPatellofemoral (particularly trochlear) cartilage thickness loss was observed in young adults following acute ACL rupture. Early ACLR was associated with greater patellofemoral (particularly patellar) cartilage thickness loss over 5 years compared with optional delayed ACLR, indicating that early surgical intervention may be associated with greater short-term structural patellofemoral cartilage deterioration compared with optional delayed surgery.Trial registration numberISRCTN84752559; Post-results.

Financial Incentives for Medicaid Beneficiaries With Diabetes: Lessons Learned From HI-PRAISE, an Observational Study and Randomized Controlled Trial

2017 ◽  
Vol 32 (7) ◽  
pp. 1498-1501 ◽  
Author(s):  
Ritabelle Fernandes ◽  
Chuan C. Chinn ◽  
Dongmei Li ◽  
Timothy Halliday ◽  
Timothy B. Frankland ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Observational Study ◽  
Clinical Outcomes ◽  
Financial Incentives ◽  
Controlled Trial ◽  
Lessons Learned ◽  
Kaiser Permanente ◽  
Randomized Controlled ◽  
Medicaid Beneficiaries ◽  
The Impact

Purpose: The Hawaii Patient Reward and Incentives to Support Empowerment (HI-PRAISE) project examined the impact of financial incentives on Medicaid beneficiaries with diabetes. Design: Observational pre–post study and randomized controlled trial (RCT). Setting: Federally qualified health centers (FQHCs) and Hawaii Kaiser Permanente. Participants: The observational study included 2003 Medicaid beneficiaries with diabetes from FQHCs. The RCT included 320 participants from Kaiser Permanente. Intervention: Participants could earn up to $320/year of financial incentives for a minimum of 1 year. Measures: (1) Clinical outcomes of change in hemoglobin A1c (HbA1c), blood pressure, and cholesterol; (2) compliance with American Diabetes Association (ADA) standards of diabetes care; and (3) cost effectiveness. Analysis: Generalized estimating equation models were used to assess differences in clinical outcomes. General linear models were utilized to estimate the medical costs per patient/day. Results: Changes in clinical outcomes in the observational study were statistically significant. Mean HbA1c decreased from 8.56% to 8.24% ( P < .0001) and low-density lipoprotein decreased from 106.17 mg/dL to 98.55 mg/dL ( P < .0001). No significant differences were found between groups in the RCT. Improved ADA compliance was observed. No reduction in total health cost during the project period was demonstrated. Conclusion: The HI-PRAISE found no conclusive evidence that financial incentives had beneficial effect on diabetes clinical outcomes or cost saving measures.

scholarly journals Corrigendum

2017 ◽  
Vol 45 (5) ◽  
pp. NP10-NP10
Keyword(s):  
Randomized Controlled Trial ◽  
Hyaluronic Acid ◽  
Knee Osteoarthritis ◽  
Clinical Outcomes ◽  
Platelet Rich Plasma ◽  
Controlled Trial ◽  
Double Blind ◽  
Randomized Controlled ◽  
Acid Versus

Cole BJ, Karas V, Hussey K, Merkow DB, Pilz K, Fortier LA. Hyaluronic acid versus platelet-rich plasma: a prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. Am J Sports Med. 2017;45(2):339-346. (Original DOI: 10.1177/0363546516665809 )

scholarly journals Early surgical reconstruction versus rehabilitation with elective delayed reconstruction for patients with anterior cruciate ligament rupture: COMPARE randomised controlled trial

BMJ ◽  
2021 ◽  
pp. n375
Author(s):  
Max Reijman ◽  
Vincent Eggerding ◽  
Eline van Es ◽  
Ewoud van Arkel ◽  
Igor van den Brand ◽  
...  
Keyword(s):  
Acl Reconstruction ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
International Knee Documentation Committee ◽  
Knee Function ◽  
Surgical Reconstruction ◽  
Acute Rupture ◽  
Randomised Controlled ◽  
Reconstruction Group

Abstract Objective To assess whether a clinically relevant difference exists in patients’ perceptions of symptoms, knee function, and ability to participate in sports over a period of two years after rupture of the anterior cruciate ligament (ACL) between two commonly used treatment regimens. Design Open labelled, multicentre, parallel randomised controlled trial (COMPARE). Setting Six hospitals in the Netherlands, between May 2011 and April 2016. Participants Patients aged 18 to 65 with an acute rupture of the ACL, recruited from six hospitals. Patients were evaluated at three, six, nine, 12, and 24 months. Interventions 85 patients were randomised to early ACL reconstruction and 82 to rehabilitation followed by optional delayed ACL reconstruction after a three month period (primary non-operative treatment). Main outcomes Patients’ perceptions of symptoms, knee function, and ability to participate in sporting activities were assessed with the International Knee Documentation Committee score (optimum score 100) at each time point over 24 months. Results Between May 2011 and April 2016, 167 patients were enrolled in the study and randomised to one of two treatments (mean age 31.3; 67 (40.%) women), and 163 (98%) completed the trial. In the rehabilitation and optional delayed ACL reconstruction group, 41 (50%) patients underwent reconstruction during follow-up. After 24 months, the early ACL reconstruction group had a significantly better (P=0.026) but not clinically relevant International Knee Documentation Committee score (84.7 v 79.4 (difference between groups 5.3, 95% confidence interval 0.6 to 9.9). After three months of follow-up, the International Knee Documentation Committee score was significantly better (P=0.002) for the rehabilitation and optional delayed ACL reconstruction group (difference between groups −9.3, −14.6 to −4.0). After nine months of follow-up, the difference in the International Knee Documentation Committee score changed in favour of the early ACL reconstruction group. After 12 months, differences between the groups were smaller. In the early ACL reconstruction group, four re-ruptures and three ruptures of the contralateral ACL occurred during follow-up versus two re-ruptures and one rupture of the contralateral ACL in the rehabilitation and optional delayed ACL reconstruction group. Conclusions In patients with acute rupture of the ACL, those who underwent early surgical reconstruction, compared with rehabilitation followed by elective surgical reconstruction, had improved perceptions of symptoms, knee function, and ability to participate in sports at the two year follow-up. This finding was significant (P=0.026) but the clinical importance is unclear. Interpretation of the results of the study should consider that 50% of the patients randomised to the rehabilitation group did not need surgical reconstruction. Trial registration Netherlands Trial Register NL 2618.

scholarly journals Impact of Remote Titration Combined With Telemonitoring on the Optimization of Guideline-Directed Medical Therapy for Patients With Heart Failure: Protocol for a Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
Veronica Artanian ◽  
Valeria E Rac ◽  
Heather J Ross ◽  
Emily Seto
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trial ◽  
Clinical Outcomes ◽  
Medical Therapy ◽  
Controlled Trial ◽  
Survival Rates ◽  
Physiological Data ◽  
Randomized Controlled ◽  
Patients With Heart Failure ◽  
The Impact

BACKGROUND Guideline-directed medical therapy (GDMT), optimized to maximum tolerated doses, has been shown to improve clinical outcomes in patients with heart failure (HF). Timely use and optimization of GDMT can improve HF symptoms, reduce the burden of hospitalization, and increase survival rates, whereas GDMT deferral may worsen the progression of HF, decrease survival rates, and predispose patients to poor outcomes. However, studies indicate that GDMT remains underused, with less than 25% of patients receiving target doses in clinical practice. Telemonitoring is a potential component in the management of HF that can provide reliable and real-time physiological data for clinical decision support and facilitate remote titration of medication. OBJECTIVE The primary objective of this study is to evaluate the impact of remote titration facilitated by telemonitoring on health care outcomes, with a primary outcome measure being the proportion of patients achieving target doses. The secondary objective is to identify the barriers and facilitators that can affect the implementation and effectiveness of the intervention. METHODS A mixed methods study of a smartphone-based telemonitoring system is being conducted at the Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto. The study is based on an effectiveness-implementation hybrid design and incorporates process evaluations alongside the assessment of clinical outcomes. The effectiveness research component is assessed by a two-arm randomized controlled trial (RCT) aiming to enroll 108 patients. The RCT compares a remote titration strategy that uses data from a smartphone-based telemonitoring system with a standard titration program consisting of in-office visits. The implementation research component consists of a qualitative study based on semistructured interviews with a purposive sample of clinicians and patients. RESULTS Patient recruitment began in January 2019 at PMCC, with a total of 76 participants recruited by February 24, 2020 (39 in the intervention group and 37 in the control group). The final analysis is expected to be completed by the winter of 2021. CONCLUSIONS This study will be among the first to provide evidence on the implementation of remote titration facilitated by telemonitoring and its impact on patient health outcomes. The successful use of telemonitoring for this purpose has the potential to alter the existing approach to titration of HF medication and support the development of a care delivery model that combines clinic visits with virtual follow-ups. CLINICALTRIAL ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 INTERNATIONAL REGISTERED REPORT DERR1-10.2196/19705

scholarly journals Impact of Remote Titration Combined With Telemonitoring on the Optimization of Guideline-Directed Medical Therapy for Patients With Heart Failure: Protocol for a Randomized Controlled Trial

10.2196/19705 ◽  
2020 ◽  
Vol 9 (10) ◽  
pp. e19705 ◽  
Author(s):  
Veronica Artanian ◽  
Valeria E Rac ◽  
Heather J Ross ◽  
Emily Seto
Keyword(s):  
Heart Failure ◽  
Randomized Controlled Trial ◽  
Clinical Outcomes ◽  
Medical Therapy ◽  
Controlled Trial ◽  
Survival Rates ◽  
Physiological Data ◽  
Randomized Controlled ◽  
Patients With Heart Failure ◽  
The Impact

Background Guideline-directed medical therapy (GDMT), optimized to maximum tolerated doses, has been shown to improve clinical outcomes in patients with heart failure (HF). Timely use and optimization of GDMT can improve HF symptoms, reduce the burden of hospitalization, and increase survival rates, whereas GDMT deferral may worsen the progression of HF, decrease survival rates, and predispose patients to poor outcomes. However, studies indicate that GDMT remains underused, with less than 25% of patients receiving target doses in clinical practice. Telemonitoring is a potential component in the management of HF that can provide reliable and real-time physiological data for clinical decision support and facilitate remote titration of medication. Objective The primary objective of this study is to evaluate the impact of remote titration facilitated by telemonitoring on health care outcomes, with a primary outcome measure being the proportion of patients achieving target doses. The secondary objective is to identify the barriers and facilitators that can affect the implementation and effectiveness of the intervention. Methods A mixed methods study of a smartphone-based telemonitoring system is being conducted at the Peter Munk Cardiac Centre (PMCC), University Health Network, Toronto. The study is based on an effectiveness-implementation hybrid design and incorporates process evaluations alongside the assessment of clinical outcomes. The effectiveness research component is assessed by a two-arm randomized controlled trial (RCT) aiming to enroll 108 patients. The RCT compares a remote titration strategy that uses data from a smartphone-based telemonitoring system with a standard titration program consisting of in-office visits. The implementation research component consists of a qualitative study based on semistructured interviews with a purposive sample of clinicians and patients. Results Patient recruitment began in January 2019 at PMCC, with a total of 76 participants recruited by February 24, 2020 (39 in the intervention group and 37 in the control group). The final analysis is expected to be completed by the winter of 2021. Conclusions This study will be among the first to provide evidence on the implementation of remote titration facilitated by telemonitoring and its impact on patient health outcomes. The successful use of telemonitoring for this purpose has the potential to alter the existing approach to titration of HF medication and support the development of a care delivery model that combines clinic visits with virtual follow-ups. Trial Registration ClinicalTrials.gov NCT04205513; https://clinicaltrials.gov/ct2/show/NCT04205513 International Registered Report Identifier (IRRID) DERR1-10.2196/19705

scholarly journals Autogenic platelet-rich plasma: Types, activation methods, and applications

2016 ◽  
Vol 72 (7) ◽  
pp. 403-407
Author(s):  
Przemysław Prządka ◽  
Zdzisław Kiełbowicz ◽  
Piotr Skrzypczak
Keyword(s):  
Growth Factors ◽  
Regenerative Medicine ◽  
Tissue Regeneration ◽  
Platelet Rich Plasma ◽  
Healing Process ◽  
Clinical Work ◽  
Optimal Density ◽  
The Impact

Platelet-rich plasma (PRP) is an autogenic source of many growth factors that are a part of the healing process and tissue regeneration, which is the cause of its growing popularity in regenerative medicine. In this paper, we present a definition and characteristics of PRP, as well as ways of extracting it. We also present the issue of thrombocyte activation and the impact of thrombocytes on PRP. We explain how to obtain the optimal density of platelets in PRP, as well as its influence on tissues. Additionally, we describe some of the applications of PRP in experimental and clinical work.

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