Platelet-rich plasma to treat jumper’s knee: preliminary results

peer reviewedIntroduction: Tendinopathies, especially jumper’s knee, often remain rebel to conservative treatments. Several experimental studies have shown the healing properties of platelet and their growth factors. Researches have specifically demonstrated the platelets action as mediator and/or enhancer of tissue healing. The aim of our study was to investigate the effect of 1 injection of PRP in patients suffering from chronic jumper’s knee. Our protocol was approved by Ethic Committee of University and University Hospital of Liège. Methods: Patients performed imaging (US and MRI) and functional assessments, and a clinical examination using an algometer, before treatment and 6 weeks after PRP treatment. They were also invited to answer to questionnaire relative to pain and functional status. PRP was obtained from autologous blood using an apheresis system (COM.TEC, Fresenius). The injection of 6mL of PRP was realised without local anaesthesia into the proximal insertion of the patellar tendon. A 48h rest-time was recommended after infiltration. Afterwards, a submaximal eccentric reeducation was initiated 1 week after infiltration 3 times a week during 5 weeks. In case of pain, anti-inflammatory drugs were prohibited and patient were encouraged to take class I or II painbrakers. Results: At this time, 10 patients with jumper’s knee were included in our study. Pre-injection tests revealed pain of the upper part of the patellar tendon just below the patella, associated with loss of function. Imaging exams confirmed diagnosis. Six weeks post-injection, the clinical status was improved in all patients, with a significant decrease of algo-functional scores. The pain reported during functional assessments was decreased (in particular for the eccentric actions), yet no significant improvement of physical performances was observed. We found no significant differences between imaging exams before and 6 weeks after PRP injection. Conclusion: One in situ injection of PRP clinically improved patients with jumper’s knee 6 weeks after treatment. All the 10 patients reported a decrease of pain during day-life and through physical activities. However nor functional performances neither imaging were improved

Platelet-rich plasma (PRP) to treat patellar tendinopathy: preliminary results

Introduction: Patellar tendinopathy, often remain rebel to conservative treatments. Researches have specifically demonstrated the platelets action as mediator and/or enhancer of tissue healing. The aim of our study was to investigate the effect of 1 injection of PRP in patients suffering from chronic patellar tendinopathy. Methods: Patients performed imaging (US and MRI) and functional assessments, and a clinical examination using an algometer, before treatment and 6 weeks after PRP treatment. They were also invited to answer to questionnaire relative to pain and functional status. PRP was obtained from autologous blood using an apheresis system (COM.TEC, Fresenius). The injection of 6mL of PRP was realised without local anaesthesia into the proximal insertion of the patellar tendon. A 48h rest-time was recommended after infiltration. Afterwards, a submaximal eccentric reeducation was initiated 1 week after infiltration 3 times a week during 5 weeks. In case of pain, anti-inflammatory drugs were prohibited and patient were encouraged to take class I or II painkillers. Results: At this time, 10 patients with patellar tendinopathy were included in our study. Pre-injection tests revealed pain of the upper part of the patellar tendon just below the patella, associated with loss of function. Imaging exams confirmed diagnosis. Six weeks post-injection, the clinical status was improved in all patients, with a significant decrease of algo-functional scores. The pain reported during functional assessments was decreased (in particular for the eccentric actions), yet no significant improvement of physical performances was observed. We found no significant differences between imaging exams before and 6 weeks after PRP injection. Conclusion: One in situ injection of PRP clinically improved patients with patellar tendinopathy 6 weeks after treatment. All the 10 patients reported a decrease of pain during day-life and through physical activities. However nor functional performances neither imaging were improved

Infiltration de concentré plaquettaire dans le traitement des tendinopathies rotuliennes : résultats préliminaires

peer reviewedIntroduction : L’évolution de certaines tendinopathies, et plus particulièrement, les tendinopathies rotuliennes aussi appelées Jumper’s knee demeurent relativement rebelles aux traitements «conservateurs». Divers travaux expérimentaux ont souligné les propriétés réparatrices des plaquettes et de divers facteurs de croissances libérés localement. Ceux-ci peuvent effectivement accélérer la cicatrisation de certains tissus : os, muscles et tendons. Ces recherches ont permis de comprendre l’action plaquettaire en qualité de médiateur et/ou activateur de la cicatrisation tissulaire. Depuis janvier 2010, ce traitement des lésions tendineuses n’est plus repris sur la liste des méthodes dopantes. Matériel et méthodes : Le but de l’étude est de réaliser une injection locale de concentré plaquettaire (PRP) chez des patients présentant une tendinopathie rotulienne supérieure rebelle, évoluant depuis plus de 3 mois, n’ayant plus bénéficié de traitement physique (programme excentrique, ondes de choc) depuis 4 semaines. Les patients bénéficient d’un bilan d’imagerie (échographie et IRM), un bilan fonctionnel ainsi qu’un test clinique algique palpatoire à l’aide d’un algomètre avant le traitement et à 6 semaines. Ils sont également invités à répondre à un questionnaire relatif à l’importance de la douleur et de la situation médico-sportive et fonctionnelle. Le PRP est prélevé à partir de sang autologue par l’intermédiaire d’un système d’aphérèse. L’injection de PRP (± 6 mL) est réalisée, sans anesthésie locale, de manière stérile au niveau de l’insertion proximale du tendon rotulien. Un repos relatif 48 heures après l’infiltration est préconisé. Une rééducation excentrique complémentaire est initiée 1 semaine après l’injection. Un repos sportif spécifique de 6 semaines est maintenu. En cas de douleur, le patient ne peut pas prendre d’anti-inflammatoire mais bien un antidouleur de classe I ou II. Notre protocole a été examiné et approuvé par le Comité d’Ethique Hospitalo-Facultaire Universitaire de Liège. Résultats et discussion : Dix patients présentant une tendinopathie rotulienne supérieure chronique sont actuellement inclus dans l’étude. Les tests et évaluation pré-injection révèlent une douleur persistante à la pointe de la rotule associée généralement à une perte de fonction. L’imagerie permet de confirmer le diagnostic. A 6 semaines de l’injection de PRP, l’évolution clinique est globalement favorable, avec une diminution significative des scores algo-fonctionnels (questionnaires et EVA lors des tests fonctionnels), mais sans amélioration significative des performances physiques. Il n’y a pas non plus de différence significative quant aux explorations d’imagerie médicale 6 semaines après l’injection de PRP. Conclusion: Une injection de PRP in situ semble améliorer cliniquement les patients atteints d’une tendinopathie rotulienne supérieure, à 6 semaines post-infiltration. Cependant, celle-ci ne semble pas avoir de répercussion sur les performances fonctionnelles ni sur l’imagerie médicale après 6 semaines. Un suivi sur une période plus importante est nécessaire pour en apprécier les effets à long terme

Effect of Nutritional Deprivation after Sleeve Gastrectomy on Bone Mass, Periostin, Sclerostin and Semaphorin 4D: A Two-Year Longitudinal Study

Bariatric surgery induces bone loss, but the exact mechanisms by which this process occurs are not fully known. The aims of this 2-year longitudinal study were to (i) investigate the changes in areal bone mineral density (aBMD) and bone turnover markers following sleeve gastrectomy (SG) and (ii) determine the parameters associated with the aBMD variations. Bone turnover markers, sclerostin, periostin and semaphorin 4D were assessed before and 1, 12 and 24 months after SG, and aBMD was determined by DXA at baseline and after 12 and 24 months in 83 patients with obesity. Bone turnover increased from 1 month, peaked at 12 months and remained elevated at 24 months. Periostin and sclerostin presented only modest increases at 1 month, whereas semaphorin 4D showed increases only at 12 and 24 months. A significant aBMD decrease was observed only at total hip regions at 12 and 24 months. This demineralisation was mainly related to body weight loss. In summary, reduced aBMD was observed after SG in the hip region (mechanical-loading bone sites) due to an increase in bone turnover in favour of bone resorption. Periostin, sclerostin and semaphorin 4D levels varied after SG, showing different time lags, but contrary to weight loss, these biological parameters did not seem to be directly implicated in the skeletal deterioration

Platelet-rich plasma (PRP) to treat upper patellar tendinopathies

peer reviewedIntroduction: Tendinopathies, especially upper patellar tendinopathy also known as jumper’s knee, often remain rebel to conservative treatments. Several experimental studies have shown the healing properties of platelet and their growth factors. These factors have the potentiality to improve healing of different tissues: bones, muscles, tendons... Researches have specifically demonstrated the platelets action as mediator and/or enhancer of tissue healing. On the other hand, such treatment has been totally removed of list of doping treatments. The aim of our study was to investigate the effect of 1 injection of PRP in patients suffering from chronic jumper’s knee. Methods: Patients performed imaging (US and MRI) and functional assessments, and a clinical examination using an algometer, before treatment and 6 weeks after PRP treatment. They were also invited to answer to questionnaire relative to pain and functional status. PRP was obtained from autologous blood using an apheresis system (COM.TEC, Fresenius). The injection of 6mL of PRP was realised without local anaesthesia into the proximal insertion of the patellar tendon. A 48h rest-time was recommended after infiltration. Afterwards, a submaximal eccentric reeducation was initiated 1 week after infiltration 3 times a week during 5 weeks. In case of pain, anti-inflammatory drugs were prohibited and patient were encouraged to take class I or II painbrakers. Our protocol was approved by Ethic Committee of University and University Hospital of Liège. Results: Eighteen patients with jumper’s knee were included in our study. Pre-injection tests revealed pain of the upper part of the patellar tendon just below the patella, associated with loss of function. Imaging exams confirmed diagnosis. Six weeks post-injection, the clinical status was improved for the majority of the patients, with a significant decrease of algo-functional scores. The pain reported during functional assessments was decreased (in particular for the eccentric actions), yet no significant improvement of physical performances was observed. We found no significant differences between imaging exams before and 6 weeks after PRP injection. Conclusion: One in situ injection of PRP clinically improved patients with jumper’s knee 6 weeks after treatment. Most patients reported a decrease of pain during day-life and through physical activities. However nor functional performances neither imaging were improved. A followup at 3 months is actually in process to evaluate more long term efficacy of PRP treatment

One injection of platelet-rich plasma associated to a submaximal eccentric protocol to treat chronic jumper's knee

peer reviewedINTRODUCTION: Jumper's knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons. METHODS: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments were made before infiltration of PRP, and 6 weeks and 3 months after the infiltration, using a 10--point Visual Analogic Scale, clinical examinations with a pressure algometer, algofunctional scores (IKDC and VISA--P), functional assessments (isokinetic and optojump evaluations) and imagery (ultrasounds and MRI). The PRP was obtained with an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a standardised sub--maximal eccentric reeducation. RESULTS: Pain during daily activities significantly decreased with time. During functional evaluation, it decreased as well, but without significant functional improvement. No improvements in the imagery measurements were observed. Younger patients seemed to be more susceptible to have an improvement of pain by the PRP infiltration. CONCLUSION: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol can improve symptoms of chronic jumper's knee in patients non--responsive to classical conservative treatments

Une infiltration de plasma riche en plaquettes (PRP) améliore les symptômes des tendinopathies patellaires supérieures

peer reviewedIntroduction : Le plasma riche en plaquettes (PRP) aurait des effets bénéfiques sur les symptômes des tendinopathies grâce à la libération locale de leurs nombreux facteurs de croissance. Le but de cette étude est d’évaluer les résultats d’une injection de PRP sur la symptomatologie des patients présentant une tendinopathie patellaire supérieure. Matériels et Méthodes : Vingt patients atteints d’une tendinopathie patellaire supérieure, rebelle aux traitements conservateurs classiques depuis au moins 3 mois, ont bénéficié d’une évaluation du statut algo-fonctionnel (EVA, algomètre de pression, VISA-P et IKDC) et des performances physqiues (isocinétique et optojump), ainsi que d’un bilan d’imagerie (échographie et IRM). Ces analyses ont été réalisées en pré-injection ainsi qu’aux 6èmeet 12èmesemaines post-injection. Le test isocinétique évaluait la force des quadriceps et des ischios-jambiers des deux membres suivant différentes modalités (C60°/sec, C240°/sec et E30°/sec). Le test Optojump évaluait la détente et la puissance musculaire par la mesure de la hauteur de saut via deux modalités («Counter Movement Jump » et « Drop Jump »). Le PRP est obtenue à l’aide d’une machine d’aphérèse (COM.TEC, Fresenius-Kabi), permettant d’obtenir une concentration plaquettaire reproductible d’un patient à l’autre, en l’absence quasi totale de globules rouges et blancs. L’infiltration intratendineuse de PRP (6mL) est réalisé à la pointe de la rotule in loco dolenti sans anesthésie locale. Résultats : Les résultats de notre expérimentation démontrent qu’une seule injection locale de PRP accompagnée d’un programme de rééducation excentrique améliore significativement la cicatrisation du tendon patellaire au niveau du score EVA, de l’algomètre de pression, des scores VISA-P et IKDC. Lors du test isocinétique, seuls l’augmentation du MFM des ischios jambiers en C240°/sec, de la différence bilatérale des ischios jambiers en C60°/sec ainsi que de l’EVA en E30°/sec était significative. Les résultats optojump en terme de détente et puissance musculaire ne montrent pas d’amélioration des performances. Néanmoins, l’EVA du « Counter Movement Jump » se voit significativement diminuée après l’infiltration. Enfin, les résultats de l’imagerie (échographie et IRM) ne démontrent pas de modification significative du tendon. Conclusions : L’injection locale de PRP dans le cadre de tendinopathies patellaires supérieure permet une diminution de la symptomatologie douloureuse à 6 semaines, se poursuivant à 12 semaines. La performance fonctionnelle et l’imageries, quant à elles, ne sont pas modifiées

Platelet-rich plasma (PRP) to treat chronic upper patellar tendinopathies

Background: Upper patellar tendinopathies remain often chronic and rebel to a thorough conservative treatment. Moreover, the option of a surgical treatment could be disappointing. New treatments are being developed. Injection of PRP is one of these. Platelets contain lot of growth factors which would have the potentiality to enhance the healing process of tendons. Even if in vitro and animal experiments have demonstrated this stimulation of tendon healing process1, clinical series are subject to controversy2. Methods: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments ［VAS, clinical examination with an algometer, algofunctional scores (IKDC and VISA-P), functional assessments (isokinetic and Optojump) and imagery (ultrasounds and MRI)］were made before infiltration of PRP, and 6 weeks and 3 months after. The PRP was obtained by an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a 6-week standardised sub-maximal eccentric reeducation. Results: We observed a very significant improvement of the algofunctional status as soon as 6 weeks after the infiltration of PRP, and continued to a lesser extent up to 3 months. During functional evaluation, pain decreased as well, but without significant improvement of performances. No significant improvements in the imagery were observed. Interestingly, patients who had a VAS equal or below 1 after 3 months post-infiltration were younger (24.7 vs 32.2 y.o.). Moreover, these younger patients had a significant increase of the IKDC score (p=0.003), a significant improvement of pain during isokinetic evaluations (p<0.05), and during Optojump assessments (p=0.01). Seventy-five percent of subjects were able to return to sport, even if only half of these patients recovered the same level than before the tendinopathy. Discussion / Conclusions: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol is efficient to improve symptoms of chronic upper patellar tendinopathies, non-responsive to classical conservative treatments. However, up to now, there is no consensus on the method to prepare the PRP. Indeed, each technique could provide a very different PRP (variations in the platelet concentrations and of the amount of red and white cells)

Early clindamycin for bacterial vaginosis in pregnancy (premeva): a multicentre, double-blind, randomised controlled trial

International audienceBackground: Preterm delivery during pregnancy (<37 weeks' gestation) is a leading cause of perinatal mortality and morbidity. Treating bacterial vaginosis during pregnancy can reduce poor outcomes, such as preterm birth. We aimed to investigate whether treatment of bacterial vaginosis decreases late miscarriages or spontaneous very preterm birth.Methods: PREMEVA was a double-blind randomised controlled trial done in 40 French centres. Women aged 18 years or older with bacterial vaginosis and low-risk pregnancy were eligible for inclusion and were randomly assigned (2:1) to three parallel groups: single-course or triple-course 300 mg clindamycin twice-daily for 4 days, or placebo. Women with high-risk pregnancy outcomes were eligible for inclusion in a high-risk subtrial and were randomly assigned (1:1) to either single-course or triple-course clindamycin. The primary outcome was a composite of late miscarriage (16-21 weeks) or spontaneous very preterm birth (22-32 weeks), which we assessed in all patients with delivery data (modified intention to treat). Adverse events were systematically reported. This study is registered with ClinicalTrials.gov, number NCT00642980.Findings: Between April 1, 2006, and June 30, 2011, we screened 84 530 pregnant women before 14 weeks' gestation. 5630 had bacterial vaginosis, of whom 3105 were randomly assigned to groups in the low-risk trial (n=943 to receive single-course clindamycin, n=968 to receive triple-course clindamycin, and n=958 to receive placebo) or high-risk subtrial (n=122 to receive single-course clindamycin and n=114 to receive triple-course clindamycin). In 2869 low-risk pregnancies, the primary outcome occurred in 22 (1·2%) of 1904 participants receiving clindamycin and 10 (1·0%) of 956 participants receiving placebo (relative risk [RR] 1·10, 95% CI 0·53-2·32; p=0·82). In 236 high-risk pregnancies, the primary outcome occurred in 5 (4·4%) participants in the triple-course clindamycin group and 8 (6·0%) participants in the single-course clindamycin group (RR 0·67, 95% CI 0·23-2·00; p=0·47). In the low-risk trial, adverse events were more common in the clindamycin groups than in the placebo group (58 [3·0%] of 1904 vs 12 [1·3%] of 956; p=0·0035). The most commonly reported adverse event was diarrhoea (30 [1·6%] in the clindamycin groups vs 4 [0·4%] in the placebo group; p=0·0071); abdominal pain was also observed in the clindamycin groups (9 [0·6%] participants) versus none in the placebo group (p=0·034). No severe adverse event was reported in any group. Adverse fetal and neonatal outcomes did not differ significantly between groups in the high-risk subtrial.Interpretation: Systematic screening and subsequent treatment for bacterial vaginosis in women with low-risk pregnancies shows no evidence of risk reduction of late miscarriage or spontaneous very preterm birth. Use of antibiotics to prevent preterm delivery in this patient population should be reconsidered.French Ministry of Health