Peripheral blood mononuclear cells enhance the anabolic effects of platelet‐rich plasma on anterior cruciate ligament fibroblasts

Yoshida, Ruriko; Murray, Martha M.

doi:10.1002/jor.22183

Cited by 48 publications

(54 citation statements)

References 35 publications

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“…L‐PRP promoted a higher expression of MMPs , which are activated trough the NF‐kB p65 pathway induced by IL6 . MMPs play an essential role in remodeling of soft tissue although when over‐expressed a catabolic environment is created . In line with our results McCarrel et al showed, that 2.5% L‐PRP concentration stimulated MMP3 , whereas 20% L‐PRP promoted MMP13 expression.…”

Section: Discussionsupporting

confidence: 92%

Biologic response of human anterior cruciate ligamentocytes on collagen‐patches to platelet‐rich plasma formulations with and without leucocytes

Krismer

Cabra

May

et al. 2017

Journal Orthopaedic Research

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1Due to the poor self-healing capacities of the anterior cruciate ligament, previous primary repair 2 attempts have failed. To enhance biologic healing, platelet rich plasma and collagen scaffold 3 have shown promise in animal models. Platelet rich plasma (PRP) is already used in several 4 clinical applications although outcomes are quite debated. The purpose of this study was to 5 examine the effects of different PRP formulations during 21 days: with leucocytes and pure PRP 6 on human anterior cruciate ligament-derived ligamentocytes grown on collagen patches in 3D 7 cell cultures in vitro. Three experimental groups were formed: 2.5% leucocyte rich PRP, 2.5% 8 pure PRP, 20% leucocyte rich PRP, a negative control, and a positive control. Cell proliferation, 9 cell phenotype on mRNA transcript level, and extracellular matrix production (total collagen and 10 glycosaminoglycan content) were evaluated. DNA content and metabolic cell activity increased 11 significantly in all groups on day 21 compared to day 7, except in the negative control. No 12 changes in extracellular matrix production were detected. Different catabolic genes were induced 13 depending on the concentration of leucocyte rich PRP. PRP with and without leucocytes treated 14 anterior cruciate ligamentocytes significantly increased cell proliferation but not extracellular 15 matrix production. However, the specific activation of different catabolic genes was dependent 16 on the relative content of leucocytes.

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Section: Discussionsupporting

confidence: 92%

Biologic response of human anterior cruciate ligamentocytes on collagen‐patches to platelet‐rich plasma formulations with and without leucocytes

Krismer

Cabra

May

et al. 2017

Journal Orthopaedic Research

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“…Autologous blood is added to an extracellular matrix scaffold and held in place in the fluid environment of the knee, where the cells in the blood stimulate ligament healing. 10,11,28,37 Thus, the BEAR technique is designed for tears in which the 2 ends of the torn ligament cannot be reapproximated under compression. In this study, only 2 of the 242 screened patients were thought to have insufficient tissue on their preoperative MRI for the BEAR procedure, and no patients were found at surgery to have insufficient tissue (<50%) for the BEAR technique.…”

Section: Discussionmentioning

confidence: 99%

The Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) Procedure

Murray

Flutie

Kalish

et al. 2016

Orthopaedic Journal of Sports Medicine

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127

185

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Background:This study assessed the safety of the newly developed bridge-enhanced anterior cruciate ligament (ACL) repair (BEAR), which involves suture repair of the ligament combined with a bioactive scaffold to bridge the gap between the torn ligament ends. As the intra-articular environment is complex in its response to implanted materials, this study was designed to determine whether there would be a significant rate of adverse reaction to the implanted scaffold.Hypothesis:The primary hypothesis was that the implanted scaffold would not result in a deep joint infection (arthrocentesis with positive culture) or significant inflammation (clinical symptoms justifying arthrocentesis but negative culture). The secondary hypotheses were that patients treated with BEAR would have early postoperative outcomes that were similar to patients treated with ACL reconstruction with an autologous hamstring graft.Study Design:Cohort study; Level of evidence, 2.Methods:A total of 20 patients were enrolled in this nonrandomized, first-in-human study. Ten patients received BEAR treatment and 10 received a hamstring autograft ACL reconstruction. The BEAR procedure was performed by augmenting a suture repair with a proprietary scaffold, the BEAR scaffold, placed in between the torn ends of the ACL at the time of suture repair. The BEAR scaffold is to our knowledge the only device that fills the gap between the torn ligament ends to have current Investigational Device Exemption approval from the Food and Drug Administration. Ten milliliters of autologous whole blood were added to the scaffold prior to wound closure. Outcomes were assessed at 3 months postoperatively. The outcomes measures included postoperative pain, muscle atrophy, loss of joint range of motion, and implant failure (designated by an International Knee Documentation Committee grade C or D Lachman test and/or an absence of continuous ACL tissue on magnetic resonance images).Results:There were no joint infections or signs of significant inflammation in either group. There were no differences between groups in effusion or pain, and no failures by Lachman examination criteria (BEAR, 8 grade A and 2 grade B; ACL reconstruction, 10 grade A). Magnetic resonance images from all of the BEAR and ACL-reconstructed patients demonstrated a continuous ACL or intact graft. In addition, hamstring strength at 3 months was significantly better in the BEAR group than in the hamstring autograft group (mean ± SD: 77.9% ± 14.6% vs 55.9% ± 7.8% of the contralateral side; P < .001).Conclusion:The results of this study suggest that the BEAR procedure may have a rate of adverse reactions low enough to warrant a study of efficacy in a larger group of patients.

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“…Plateletrich plasma is a simple preparation of a complex material, and as such may be viewed as a potential platform for further development of regenerative strategies. For example, a recent study found that the effects of platelet-rich plasma on collagen production by ligament fibroblasts could be enhanced by the simultaneous presence of autologous peripheral blood mononuclear cells, suggesting a potential direction for modification of therapy [43].…”

Section: Regenerative Injection Therapy (Prolo-therapy) For Musculoskmentioning

confidence: 99%

Prolotherapy: A Non-Invasive Approach to Lesions of the Glenoid Labrum; A Non-Controlled Questionnaire Based Study

Hauser¹,

Dolan

Orlofsky³

2013

TOREHJ

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Lesions of the glenoid labrum are a common cause of shoulder instability and a frequent finding in patients with shoulder pain. Management of these patients typically involves an attempt to avoid surgery through conservative treatment. However, there is currently a dearth of conservative options that promote labral healing. Regenerative injection therapies, including prolotherapy, have shown promise in the treatment of several musculoskeletal disorders, but have not previously been applied to glenoid labral tear. Here we review several important aspects of these lesions and present an initial case series of 33 patients with labral tear that were treated in our clinic with intra-articular injections of hypertonic dextrose. Patient-reported assessments were collected by questionnaire at a mean follow-up time of 16 months. Treated patients reported highly significant improvements with respect to pain, stiffness, range of motion, crunching, exercise and need for medication. All 31 patients who reported pain at baseline experienced pain relief, and all 31 who reported exercise impairment at baseline reported improved exercise capability. Patients reported complete relief of 69% of recorded symptoms. One patient reported worsening of some symptoms. Prolotherapy for glenoid labral tear appears to be a safe procedure that merits further investigation.

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Peripheral blood mononuclear cells enhance the anabolic effects of platelet‐rich plasma on anterior cruciate ligament fibroblasts

Cited by 48 publications

References 35 publications

Biologic response of human anterior cruciate ligamentocytes on collagen‐patches to platelet‐rich plasma formulations with and without leucocytes

Biologic response of human anterior cruciate ligamentocytes on collagen‐patches to platelet‐rich plasma formulations with and without leucocytes

The Bridge-Enhanced Anterior Cruciate Ligament Repair (BEAR) Procedure

Prolotherapy: A Non-Invasive Approach to Lesions of the Glenoid Labrum; A Non-Controlled Questionnaire Based Study

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