Platelet-rich plasma: combinational treatment modalities for musculoskeletal conditions / 医学前沿

Current research on common musculoskeletal problems, including osteoarticular conditions, tendinopathies, and muscle injuries, focuses on regenerative translational medicine. Platelet-rich plasma therapies have emerged as a potential approach to enhance tissue repair and regeneration. Platelet-rich plasma application aims to provide supraphysiological concentrations of platelets and optionally leukocytes at injured/pathological tissues mimicking the initial stages of healing. However, the efficacy of platelet-rich plasma is controversial in chronic diseases because patients' outcomes show partial improvements. Platelet-rich plasma can be customized to specific conditions by selecting the most appropriate formulation and timing for application or by combining platelet-rich plasma with synergistic or complementary treatments. To achieve this goal, researchers should identify and enhance the main mechanisms of healing. In this review, the interactions between platelet-rich plasma and healing mechanisms were addressed and research opportunities for customized treatment modalities were outlined. The development of combinational platelet-rich plasma treatments that can be used safely and effectively to manipulate healing mechanisms would be valuable and would provide insights into the processes involved in physiological healing and pathological failure.

Usefulness of rehabilitation in patients with rotator cuff calcific tendinopathy after ultrasound-guided percutaneous treatment

To evaluate the efficacy of a specific rehabilitation program for patients in whom ultrasound-guided percutaneous treatment [UGPT] was performed for rotator cuff calcific tendinopathy [RCCT]. In this prospective observational study, 86 patients [22 males and 64 females] with shoulder calcific tendinopathy treated with UGPT were enrolled. At the end of the procedure, a corticosteroid injection into the subacromial-subdeltoid bursa was performed. The patients were then asked to follow a specific rehabilitation protocol [2 times/week for 5 weeks] that focused on mobility, strength and function. At baseline and after 6 weeks, clinical parameters, visual analog scale [VAS] and Constant-Murley scale [CMS] scores and ultrasound [US] features were collected. The mean age of the patients was 48.9 +/- 8.4 years and their mean BMI was 22.7 +/- 2.1. Considering the whole cohort, the treatment was effective, with a significant decrease in the VAS score and an improvement in the CMS score. Thereafter, on the basis of the compliance to the rehabilitation program [by self-report], 53 and 33 patients were included in the rehabilitation group [Rehab group; performed exercises >/= 2 times/week] and the No Rehab group [performed exercises <2 times/week], respectively. The comparison between the groups showed that the subjects who performed the exercises regularly had better results in terms of pain and functional recovery, and less associated diseases [e.g. adhesive bursitis and tenosynovitis of the long head of the biceps] than those who were less compliant with the program. UGPT, followed by a specific postprocedure rehabilitation program, was an effective treatment for RCCT

Revisiting physical examination: Abadie's sign and achilles intratendinous changes in subjects with diabetes

The aim of this study was to evaluate whether or not the positivity of Abadie's sign could be an indicator of asymptomatic Achilles intratendinous changes. A total of 18 patients [36 tendons] suffering from diabetes, with at least 1 Achilles tendon positive to Abadie's sign, were compared to matched subjects with diabetes bilaterally negative to Abadie's sign. Anthropometric measures and the Toronto Clinical Neuropathy Score were registered. Echotexture was evaluated and degenerative features classified as absent, mild, moderate and severe. The frequencies of structural abnormalities, according to both Abadie's sign and the Toronto Clinical Neuropathy Score, were determined. In the first group 26 out of 36 tendons [72.2%] showed positive Abadie's sign and a significantly higher frequency of moderate and severe [65.3%] structural abnormalities compared to Achilles tendons with negative sign [4.3%; p < 0.0001]. This frequency was similar to that observed in the subjects with the highest Toronto Clinical Neuropathy Score [64.2%]. This study showed that Abadie's sign was a useful tool for assisting in the diagnosis of asymptomatic Achilles intratendinous changes, which, when detected early, could help prevent unexpected tendon rupture. The concordance between Abadie's sign and Achilles sonographic abnormalities needs to be evaluated in a larger sample to consider it useful for practical purposes