{"id":11107,"date":"2016-06-28T19:09:06","date_gmt":"2016-06-28T19:09:06","guid":{"rendered":"http:\/\/phosdev.com\/todaysveterinarypractice\/?p=11107"},"modified":"2022-02-16T21:48:05","modified_gmt":"2022-02-16T21:48:05","slug":"regenerative-medicine-for-soft-tissue-injury-osteoarthritis","status":"publish","type":"post","link":"https:\/\/navc.sitepreview.app\/todaysveterinarypractice.com\/orthopedics\/regenerative-medicine-for-soft-tissue-injury-osteoarthritis\/","title":{"rendered":"Regenerative Medicine for Soft Tissue Injury and Osteoarthritis"},"content":{"rendered":"
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Regenerative medicine therapy has become increasingly popular in both human and veterinary medicine for treatment of multiple disease processes, and recent studies have demonstrated its efficacy in managing numerous orthopedic conditions in humans, dogs, and horses, including osteoarthritis and soft tissue injuries.1-13<\/sup><\/p>\n<\/div>\n

While some tissues can heal to their original or near-original strength and stiffness, other tissues, such as cartilage, heal poorly. Regenerative medicine has been used to stimulate healing in areas that have not responded to more traditional approaches, helping injured tissues heal to their original or near-original condition.<\/p>\n

Regenerative medicine is often used as an adjunct to surgical, medical, and\/or rehabilitation therapy in a multimodal approach to treat a condition or injury. As with any other treatment modality, it is important to obtain a definitive diagnosis and tailor an appropriate treatment plan for the patient.<\/p>\n

Platelet-Rich Plasma Therapy<\/h2>\n

Platelet-rich plasma (PRP) is an autogenous fluid concentrate composed primarily of platelets and growth factors. Recent studies indicate that PRP mediates healing by supplying growth factors, cytokines, chemokines, and other bioactive compounds.14,15<\/sup><\/p>\n

PRP is used in both humans and animals to aid healing in numerous tissues. Recent studies have shown PRP to be efficacious in managing many different orthopedic conditions, including osteoarthritis and soft tissue injuries.1,2,16-36<\/sup> One recent study in dogs with partially transected cranial cruciate ligaments and meniscal release demonstrated improved range of motion, decreased pain, and improved limb function for up to 6 months\u2014after treatment with 5 intra-articular injections of leukoreduced PRP\u2014compared with the control group.37<\/sup><\/p>\n

Role in Tissue Healing<\/strong><\/h3>\n

Platelets play roles in both hemostasis and wound healing, and PRP has been used as a regenerative medicine therapy to aid in tissue healing.<\/p>\n

Platelets contain alpha granules that release growth factors to stimulate other cells of the body to migrate to the area of trauma, facilitating tissue healing. The growth factors\u2014including platelet-derived, vascular endothelial, basic fibroblastic, and epidermal growth factors and transforming growth factor beta1 and beta2\u2014contained within the platelets are important for tissue healing.1,2,14-16<\/sup><\/p>\n

Many growth factors act individually or synergistically to enhance cellular migration and proliferation, angiogenesis, and matrix deposition, which promotes tendon and wound healing, aids in cartilage health, and counteracts the cartilage breakdown associated with osteoarthritis.1-3,5,6,15-20,25-28,31,34,36 <\/sup>Platelets also recruit, stimulate, and provide a scaffold for stem cells.32,36,38-45<\/sup><\/p>\n

Components of PRP<\/strong><\/h3>\n

Multiple formulations of PRP have been developed and studied. Previous studies in humans suggest that the ideal PRP product should lead to a 4- to 7-fold increase in platelets.1,2,14,15,17<\/sup><\/p>\n

However, platelet concentration is not the only important component of a PRP product. Inclusion or exclusion of mononuclear cells, neutrophils, and red blood cells not only defines an autologous platelet product but also affects the clinical efficacy of the product and the inflammatory responses after PRP injection.15,16,19,25-28,46-50<\/sup> In general, red blood cells and neutrophils should be reduced because they have an inflammatory effect, while the effect of mononuclear cells remains largely unknown.42,46,47,51-54<\/sup><\/p>\n

Recent studies compared key parameters of the PRP product from the commonly used commercial canine PRP systems in healthy, adult canines and found variations in product composition.50,55,56<\/sup><\/p>\n

Performing PRP Therapy<\/strong><\/h3>\n

PRP therapy is a minimally invasive procedure that typically can be performed on an outpatient basis. It is often performed as a series of 1 to 3 injections, with 2 weeks between each injection. If PRP is being used to manage moderate to severe osteoarthritis, in my experience, about 50% of dogs require more than 1 injection for significant improvement.<\/p>\n

To perform PRP therapy:<\/p>\n