Rodilla/Knee/Knie/Genou: ¿Un remedio milagroso para la rodilla lesionada?

Platelet Rich Plasma and Knee Surgery
Mikel Sánchez, Diego Delgado, Pello Sánchez, Nicolás Fiz, Juan Azofra, Gorka Orive, Eduardo Anitua, Sabino Padilla
Biomed Res Int. 2014; 2014: 890630.
Published online Sep 2, 2014

Abstract

In orthopaedic surgery and sports medicine, the knee joint has traditionally been considered the workhorse. The reconstruction of every damaged element in this joint is crucial in achieving the surgeon's goal to restore the knee function and prevent degeneration towards osteoarthritis. In the last fifteen years, the field of regenerative medicine is witnessing a boost of autologous blood-derived platelet rich plasma products (PRPs) application to effectively mimic and accelerate the tissue healing process. The scientific rationale behind PRPs is the delivery of growth factors, cytokines, and adhesive proteins present in platelets and plasma, as well as other biologically active proteins conveyed by the plasma such as fibrinogen, prothrombin, and fibronectin; with this biological engineering approach, new perspectives in knee surgery were opened. This work describes the use of PRP to construct and repair every single anatomical structure involved in knee surgery, detailing the process conducted in ligament, meniscal, and chondral surgery.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167644/

Codo/Elbow/Ellbogen/Coude: Epicondilitis para perder los nervios

Epicondylitis and denervation surgery
Rose, Nicholas E.a; Dellon, A. Leeb
Current Orthopaedic Practice:
September/October 2014 - Volume 25 - Issue 5 - p 446-452

Abstract
Lateral and medial epicondylitis are two of the most common musculoskeletal conditions affecting the upper extremity. Yet, their exact etiology and optimal treatment remain controversial. Even the efficacy of traditional nonoperative treatments, such as physical therapy and corticosteroid injections, is disputed, with many studies failing to demonstrate long-term benefits with either modality. Newer treatments, such as extracorporeal shock wave therapy and platelet rich plasma, show promise. However, despite the theoretic advantages of these treatments, clinical results remain mixed. When nonoperative treatments fail, traditional surgery in the form of a medial or lateral release remains the mainstay of treatment. However, recovery times from these open release procedures remain prolonged. Recent clinical trials evaluating medial and lateral elbow denervation surgery show that these less invasive techniques may bring permanent resolution to this difficult problem with less pain and shorter recovery times.

Rodilla/Knee: faltan pruebas para usar PRP en la ligamentoplastia

Use of platelet rich plasma in knee ligament surgery

David Figueroa P, Francisco Figueroa B, Ahumada P Ximena, Rafael Calvo R, Alex Vaisman B

Revista Médica de Chile 2013, 141 (10): 1315-20

Platelet Rich Plasma (PRP) is used in musculoskeletal lesion surgery, including muscle, bone, tendons and ligaments. PRP might accelerate the healing process and the integration of the graft, allowing an earlier return to sports activities of patients. PRP is obtained from autologous blood, which is centrifuged, obtaining platelet and supposedly growth factor concentrations three to five times higher than those of regular blood. The clinical results of studies performed in Chile and elsewhere on PRP use in knee anterior cruciate ligament (ACL) reconstruction have been variable. Therefore, there is not enough evidence to support or deny the usefulness of PRP in ACL reconstructions.

Rodilla/Knee: artrosis y combinar PRP con ácido hialurónico

Knee osteoarthritis: hyaluronic acid, platelet-rich plasma or both in association?

Expert Opinion on Biological Therapy 2014 February 17
Isabel Andia, Michele Abate

Introduction: Bidirectional interactions between cells and fluidic surroundings regulate cellular functions and maintain tissue or organ architecture. Accordingly, the synovial fluid is the primary source of environmental signals and determines to a great extent the molecular interactions within the joint capsule, both in homeostasis and pathology.

Areas covered: We provided an update on hyaluronic acid (HA) and platelet-rich plasma (PRP) concepts necessary to build the rationale for creating a combined treatment. The information is based on a PubMed search using the terms 'platelet-rich plasma', 'hyaluronic acid', 'knee pathology', 'knee osteoarthritis' (OA). 

Expert opinion: In OA, a deleterious fluidic microenvironment is established, with presence of HA fragments, catabolic enzymes and inflammatory molecules. The central concept underlying intra-articular injection is to modify deleterious fluidic microenvironments. PRP administration has shown pain remission and function improvement, but less than half of the patients showed clinically significant improvement. PRP exceeds HA, the comparator used in PRP clinical trials, albeit both HA and PRP alleviate symptoms in mild-to-moderate OA patients. Combining PRP and HA may benefit from their dissimilar biological mechanisms and help in controlling delivery and presentation of signaling molecules. Three armed randomized studies, using both HA and PRP as comparators, will provide information about the impact of this approach.