Ultrasonography in Regenerative Injection (Prolotherapy) Using Dextrose, Platelet-rich Plasma, and Other Injectants

Fullerton, Bradley D.; Reeves, Kenneth Dean

doi:10.1016/j.pmr.2010.06.003

Cited by 30 publications

(16 citation statements)

References 32 publications

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“…It is of interest that glucose solutions at concentrations between 12% and 20% have been used in prolotherapy injections with varying results. 1 , 11 , 20 It is likely this is derived from the use of the ACD-A and is thus related to the preparation technique consistent to all kits. If one takes 5 mL of a 10% glucose solution (2.8-mmol solution) for injection, this would contain 0.5 g of glucose.…”

Section: Discussionmentioning

confidence: 99%

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Analysis of Platelet-Rich Plasma Extraction

Fitzpatrick

Bulsara

McCrory

et al. 2017

Orthopaedic Journal of Sports Medicine

151

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Background:Platelet-rich plasma (PRP) has been extensively used as a treatment in tissue healing in tendinopathy, muscle injury, and osteoarthritis. However, there is variation in methods of extraction, and this produces different types of PRP.Purpose:To determine the composition of PRP obtained from 4 commercial separation kits, which would allow assessment of current classification systems used in cross-study comparisons.Study Design:Controlled laboratory study.Methods:Three normal adults each donated 181 mL of whole blood, some of which served as a control and the remainder of which was processed through 4 PRP separation kits: GPS III (Biomet Biologics), Smart-Prep2 (Harvest Terumo), Magellan (Arteriocyte Medical Systems), and ACP (Device Technologies). The resultant PRP was tested for platelet count, red blood cell count, and white blood cell count, including differential in a commercial pathology laboratory. Glucose and pH measurements were obtained from a blood gas autoanalyzer machine.Results:Three kits taking samples from the “buffy coat layer” were found to have greater concentrations of platelets (3-6 times baseline), while 1 kit taking samples from plasma was found to have platelet concentrations of only 1.5 times baseline. The same 3 kits produced an increased concentration of white blood cells (3-6 times baseline); these consisted of neutrophils, leukocytes, and monocytes. This represents high concentrations of platelets and white blood cells. A small drop in pH was thought to relate to the citrate used in the sample preparation. Interestingly, an unexpected increase in glucose concentrations, with 3 to 6 times greater than baseline levels, was found in all samples.Conclusion:This study reveals the variation of blood components, including platelets, red blood cells, leukocytes, pH, and glucose in PRP extractions. The high concentrations of cells are important, as the white blood cell count in PRP samples has frequently been ignored, being considered insignificant. The lack of standardization of PRP preparation for clinical use has contributed at least in part to the varying clinical efficacy in PRP use.Clinical Relevance:The variation of platelet and other blood component concentrations between commercial PRP kits may affect clinical treatment outcomes. There is a need for standardization of PRP for clinical use.

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Section: Discussionmentioning

confidence: 99%

“…It is of interest that glucose solutions at concentrations of between 12% and 20% have been used in prolotherapy injections with varying results. 1 , 11 , 20 The clinical significance of this remains uncertain. This was thought to be important as prolotherapy with glucose has been used in the treatment of musculoskeletal injuries.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Platelet-Rich Plasma Extraction

Fitzpatrick

Bulsara

McCrory

et al. 2017

Orthopaedic Journal of Sports Medicine

151

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“…Inflammatory factors such as granulocytes and macrophages are recruited; growth factors and cytokines are released; the inflammatory cascade is induced; and healing is promoted. However, recent studies have concluded that the release of multiple cytokines and growth factors can occur in the absence of an injectant or inflammation, and elevation of DNA expression that favors the production of multiple cytokines in a variety of animal and human cells can be achieved by exposure to as little as 0.6% dextrose in water . Pain relief achieved by prolotherapy may be related to stimulation of local healing, promotion of cellular proliferation, and reduction of joint instability through the strengthening of weakened ligaments .…”

Section: Discussionmentioning

confidence: 99%

Ultrasound‐Guided Prolotherapy for Acromial Enthesopathy and Acromioclavicular Joint Arthropathy: A Single‐Arm Prospective Study

Hsieh

Chiou

Wang

et al. 2018

J of Ultrasound Medicine

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“…These case reports demonstrate the successful use of a combined dextrose-PRP injection therapy utilizing Hackett's Method. With the addition of an ultrasound-guided approach to target lumbosacral structures, all procedures were successfuly performed safely and accurately in an office setting [10]. Although ultrasound has limited diagnostic value in the spine, it aids in identifying target structures ( Figure 1) and landmarks ( Figure 2).…”

Section: Discussionmentioning

confidence: 99%