Other Key Research

Important Related Research

While the research detailed on this page is not fall strictly within the field of prolotherapy,
these key studies are related to the shared goal of tissue repair.

 

Autologous chrondrocyte implantation: Gobbi et al 2009.

Gobbi A; Kon E; Berruto M; Filardo G; Delcogliano M; Boldrini L; Bathan L; Marcacci M. Patellofemoral full-thickness chondral defects treated with second-generation autologous chondrocyte implantation: results at 5 years' follow-up. Am J Sports Med, Jun 2009, 37(6) p1083-92

Dr. Reeves' Notes:  High points include young and healthy patients with primarily patellar lesions, one surgery (arthroscopy) for harvest, cost of chondrocyte isolation and culture expansion and implantation in a hyaluronic based scaffold over a 1 month period , second surgery, followed by a long rehab course with moderate risk range of motion limitation progressive over 8 weeks, no running for 6 months and no high impact running for 1 year. Despite good fill of grafts on 2nd look arthroscopy which was conducted in a few patients, declines after 2 years were noted and previous level of sports activity was not achieved. This was primarily a group with patellar cartilage lesions.

The abstract is available below...

BACKGROUND: Patellofemoral lesions represent a very troublesome condition to treat for orthopaedic surgeons; however, second-generation autologous chondrocyte implantation (ACI) seems to offer an interesting treatment option with satisfactory results at short-term follow-up.

HYPOTHESIS: Hyaluronan-based scaffold seeded with autologous chondrocytes is a viable treatment for the damaged articular surface of the patellofemoral joint.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Among a group of 38 patients treated for full-thickness patellofemoral chondral lesions with second-generation ACI, we investigated 34 who were available for final follow-up at 5 years. These 34 had chondral lesions with a mean size of 4.45 cm(2). Twenty-one lesions were located on the patella, 9 on the trochlea, and 4 patients had multiple lesions: 3 had patellar and trochlear lesions, and 1 had patellar and lateral femoral condyle lesions. Twenty-six lesions (76.47%) were classified as International Cartilage Repair Society (ICRS) grade IV A or B, 5 lesions (14.70%) were grade IIIC, and 3 (8.82%) were lesions secondary to osteochondritis dissecans (OCD). Results were evaluated using the International Knee Documentation Committee (IKDC) 2000 subjective and objective scores, EuroQol (EQ) visual analog scale (VAS), and Tegner scores at 2 and 5 years. Eight patients had second-look arthroscopy and biopsies.

RESULTS: All the scores used demonstrated a statistically significant improvement (P < .0005) at 2 and 5 years' follow-up. Objective preoperative data improved from 8 of 34 (23.52%) normal or nearly normal knees to 32 of 34 (94.12%) at 2 years and 31 of 34 (91.17%) at 5 years after transplantation. Mean subjective scores improved from 46.09 points preoperatively to 77.06 points 2 years after implantation and 70.39 at 5 years. The Tegner score improved from 2.56 to 4.94 and 4.68, and the EQ VAS improved from 56.76 to 81.47 and 78.23 at 2 and 5 years' follow-up, respectively. A significant decline of IKDC subjective and Tegner scores was found in patients with multiple and patellar lesions from 2 to 5 years' follow-up. Second-look arthroscopies in 8 cases revealed the repaired surface to be nearly normal with biopsy samples characterized as hyaline-like in appearance.

CONCLUSION: Hyaluronan-based scaffold seeded with autologous chondrocytes can be a viable treatment for patellofemoral chondral lesions.

AUTHOR'S ADDRESS: Orthopaedic Arthroscopic Surgery International Bioresearch Foundation, 24 Via Amadeo GA, Milan 20133, Italy. sportmd@tin.it.

 

Aprotinin injection: Orchard et al 2008: Aprotinin injection helps repair Achilles and patellar tendon damage. 

Orchard J; Massey A; Brown R; Cardon-Dunbar A; Hofmann J. Successful management of tendinopathy with injections of the MMP-inhibitor aprotinin. Clin Orthop Relat Res (United States), Jul 2008, 466(7) p1625-32

Dr. Reeves' Notes:  Injection of Solutions that block breakdown of tissue may also help healing. Metalloproteinase (Collagenase is an example) breaks down issue and an inhibitor of metalloprotinease has been found to help some cases of tendon damage.

The abstract is available below...

SUMMARY: Aprotinin is a broad spectrum proteinase inhibitor (including matrix metalloproteinase [MMP] inhibitor) used for treating patellar and Achilles tendinopathies. One previous randomized control trial demonstrated aprotinin injections superior to both corticosteroid and saline injections in patellar tendinopathy (Level II), whereas results reported for aprotinin treatment in Achilles tendinopathy have been mixed. We performed a case review and followup questionnaire for 430 consecutive patients with tendinopathy treated by 997 aprotinin injections (30,000 KIU). A response rate of 72% was achieved with a minimum followup of 3 months (average, 12.2 months; range, 3-54 months). Seventy-six percent of patients had improved, 22% of patients reported no change, and 2% were worse. Sixty-four percent of patients thought aprotinin injections were helpful, while 36% believed they had neither a positive nor negative effect. Mid-Achilles tendinopathy patients (84% improvement) were more successfully treated than patellar tendinopathy patients (69% improvement). Despite stronger published evidence of benefit in patellar tendinopathy, clinical outcomes appeared better with aprotinin use in Achilles tendinopathies.

LEVEL OF EVIDENCE: Level IV, case series.

 

K. Dean Reeves, M.D. is a physician and medical researcher in the area of pain caused by arthritis, chronic sprains and chronic strains. His private practice is located in the greater Kansas City area of Roeland Park, Kansas.  He collaborates in research with other locations across the country and internationally, and is licensed in the states of Kansas and Missouri.

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Copyright 2011-2014
Dr. K. Dean Reeves

No part of this site should be understood to be personal medical advice or instruction in how to perform injection therapy. A decision on treatment requires a good history and full examination and a knowledge of your treatment goals. Treatment decisions should be made in consultation with your personal healthcare professional and/or prolotherapist.