ABSTRACT
Background Plantar fasciitis is the most common cause of foot pain. Patients with plantar fasciitis typically present with 'first step pain,' which tends to decrease with activity and worse with heavy use. This study determines the effect of ultrasound-guided, single-dose, platelet-rich plasma (PRP) injection in patients with chronic plantar fasciitis. Materials and methods It was a quasi-experimental trial carried out in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2019 to March 2022. A total of 148 patients diagnosed with chronic plantar fasciitis were selected as samples. A total of 75 patients were allocated to group A (intra-lesional injection of autologous PRP with conservative management) and 73 patients to Group B (only conservative management). Both groups of patients were allocated to conservative management with exercises, shoe modification, activities of daily living (ADLs) instruction, and oral paracetamol. Results This study shows that in group A, the mean visual analog scale (VAS) score significantly reduced to 1.47±0.51 after six months of single-dose PRP injection (p<0.001). In group B, the VAS score also decreased substantially after conservative treatment. Though in groups A and B, pain reduction was significant, in group A, the pain was decreased more compared to group B and statistically significant differences were found between the two groups at the 12th week and 24th week. The foot function index (FFI) scores decreased significantly in group A after a single dose PRP injection, compared with group B treated with conventional therapy. In group A, FFI scores decreased from 49.09±5.72 to 7.67±3.41. The study revealed a significant difference between study groups in the 12th week and 24th week regarding FFI scores. Conclusion Ultrasound-guided intra-lesional autologous PRP Injection is safe and effective and recommended in patients with chronic plantar fasciitis, especially in recalcitrant cases after the failure of conservative treatment and corticosteroid injection.
ABSTRACT
INTRODUCTION: Mesenchymal stem cell (MSC) therapy appeared promising in knee osteoarthritis (OA). We examined if a single intra-articular (IA) autologous total stromal cells (TSC) and platelet-rich plasma (PRP) injection improved knee pain, physical function, and articular cartilage thickness in knee OA. METHODS: The study was performed in the physical medicine and rehabilitation department of Bangabandhu Shaikh Mujib Medical University, Dhaka, Bangladesh. Knee OA was diagnosed according to the American College of Rheumatology criteria and randomly assigned to treatment (received TSC and PRP) and control groups. Kallgreen-Lawrance (KL) scoring system was used to grade primary knee OA. The Visual Analogue Scale (VAS, 0-10 cm) for pain, WOMAC (Western Ontario and McMaster Universities Arthritis Index) for physical function, and medial femoral condylar cartilage (MFC) thickness (millimeters) under ultrasonogram (US) were documented and compared between groups before and after treatment. Statistical Package analyzed data for Social Scientists (SPSS 22.0; IBM Corp, Armonk, NY) was used for data analysis. Pre- and post-intervention outcomes were measured using the Wilcoxon-sign test, whereas Mann-Whitney U-test calculated the difference between groups; a p-value <0.05 was considered statistically significant. Result: In the treatment group, 15 received IA-TSC and PRP preparation, and in the control group, 15 patients received no injection, but quadricep muscle-strengthening exercise. There was no significant difference between groups regarding VAS for pain, WOMAC physical function, and cartilage thickness before starting the treatment and two weeks after intervention. VAS for pain and WOMAC physical function scores improved profoundly in the treatment group after 12 and 24 weeks of intervention; the pain and physical function scores difference between groups was also significant. However, significant mean femoral cartilage thickness was not changed until the end of 24 weeks (U=175.00, p=0.009 two-tailed and U= 130.00, p=0.016 two-tailed, respectively, for right and left knee). CONCLUSION: Single TSC and PRP injection reduces knee pain and improves physical function and cartilage thickness in knee OA. While pain and physical function improvement happen earlier, cartilage thickness change takes more time.
