Cell Therapy in Orthopedic and Cartilage Healing - New Frontiers Rogerio Teixeira da Silva, MD. PhD Chairman - NEO Orthopedic Sports Medicine Samaritano Hospital - São Paulo, Brazil Director - Brazilian Orthopedic Society for Sports Medicine Toronto, May 14th 2013 www.neo.org.br http://docroger.blogspot.com
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Cell Therapy in Orthopedic and Cartilage Healing - New Frontiers
Rogerio Teixeira da Silva, MD. PhDChairman - NEO Orthopedic Sports MedicineSamaritano Hospital - São Paulo, BrazilDirector - Brazilian Orthopedic Society for Sports Medicine
Soccer, male, 47 yo - October 2006 - complete rupture
January 2007(3 months)
Courtesy: JL Runco
Tennis elbowPRP therapy for chronic tendon pathology around the elbow joint
Clinical Case 1 (amateur)FMC, 44 yo, male, elbow pain 8 mponths (PT + SWT without resolution of the pain)
Proposed treatment - US guided PRP injection (2ml) / non activated / tendon dry needling
4 WEEKS POS PRPNO SYMPTONS
Clinical Case 1 (amateur)
RTP AFTER6 WEEKS
2 year follow-up MRIA - MRI before treatment
(coronal, T2 fat)B - 2 year FU MRI(coronal, T2 fat)
RCCA, 66 yo, male, tennis player (8hs/week), pain at the R elbow during the last 2 years (PT 65 sections / acupunture)
Partial rupture 1,2cm (ERC tendon)
Clinical Case 2 (amateur)
5 WEEKS - PAIN VAS = 2
PRP injection (2.5ml) guided by US
PT after 5 days
Clinical Case 2 (amateur)
Rotator CuffUse of PRP injection for the treatment of RC patology (partial tears (articular) / tendinopathy
Clinical case - RC partial tear
RBF, 65 yo, male, amateur tennis player, R shoulder pain last 3 years (PT / acupunture / 2 CE infiltration)
Partial tear 1,0cm (PASTA)
Infiltration of 2.5ml of PRP - non activated
O QuickTime™ e umDVCPRO50 - NTSC descompressor
são necessários para ver esta imagem.
Clinical case - RC partial tear
Pain (moderate) during the first 3 days (analgesic drug for this period)
Pain decreased progressively
2 weeks FU: it is possible to sleep without pain
6 WEEKS - POSTNO PAIN
US showing no doppler active sites with healing
Clinical case - RC partial tear
Caso Clínico - MR (amador)
6 WEEKS - POSTNO PAIN
Muscle rupturePRP treatment for partial and complete muscle ruptures
Clinical Case - Tennis leg
FF, 44yo, male, business man, amateur tennis player
Pain at the R calf when running to the net (4 hours ago)
Muscle rupture (g.3) medial gastroc. (5 cm)
D D E D E
PRP injection guided by US (48 hours after the injury)
6ml (total)
O QuickTime™ e umMicrosoft Video 1 descompressor
são necessários para ver esta imagem.
Clinical Case - Tennis leg
Return to tennis = 3 weeks (no pain 1 week after the injection)
FU (2 years and 6 months) = normal
US (CONTROL) = 4 WEEKS
Clinical Case - Tennis leg
Knee OsteoarthitisPRP treatment for mild to moderate OA of the knee
Evidence - Level 2
Spakova et al, Am J Phys Med Rehabil 2012; 91: 411-17
Conclusions: Our preliminary findings support the application of autologous PRP as an effective and safe method in the treatment of the initial stages of knee osteoarthritis. Further studies are needed to confirm these results and to investigate the persistence of the beneficial effects observedLevel of Evidence: Level II, cohort prospective study
120 patients / HA vs PRP (up to 6 months follow-up)
Spakova � T, Rosocha J, Lacko M, Harvanova � D, Gharaibeh A: Treatment of knee joint osteoarthritis with autologous platelet-rich
plasma in comparison with hyaluronic acid. Am J Phys Med Rehabil 2012; 91:411-417.
Evidence - Level 1
Sanchez et al, Arthroscopy 2012; 28(8): 1070-78
Conclusions: Plasma rich in growth factors showed superior short-term results when compared with HA in a randomized controlled trial, with a comparable safety profile, in alleviating symptoms of mild to moderate osteoarthritis of the knee. Level of Evidence: Level I, randomized controlled multi-center trial
176 patients / RCT HA vs PRP (up to 24 weeks of follow-up)
Evidence - Level 1
Sanchez et al, Arthroscopy 2012; 28(8): 1070-78
Personal Experience
5 years - 365 cases (in protocols - RC, Achilles, Elbow, Patella, Muscle,
Chondral injury - knee)
- more than 6 months of pain, chronic, more than 2 treatments without
success, indication for surgery
* Tennis elbow paper: 78 cases - minimum FU of 1 year (clinical)
- 75,6% of the patients (59) return to play tennis (same level)
- average = RTP after 8 weeks and 3 days (5 to 16 weeks)
- Failure:
*Surgery on 8 patients (10,25%)
* Lost to FU or stop to play tennis = 11 (14,15%)
Adult Mesenquimal Stem Cell
New treatment, with old concepts = restore cartilage cells
- fat = a good source for harvesting the stem cell
- Lipoaspirate samples = perfect for culture (protocol = Baptista et al, 2009)
Adipose Mesenquimal Stem Cell
New treatment, with old concepts = restore cartilage cells
- fat = a good source for harvesting the stem cell
- Lipoaspirate samples = perfect for culture (protocol = Baptista et al, 2009)
Stem Cell - Tendons
Carvalho AM et al, 2011
Protocol - Chondral Injury (Knee)
Example of a grade III medial femural condyle chondral injury