Current Issue Volume 52, Number 2 , April-June 2018

EDITORIAL
Pam Jackson, William D. Murrell

Biologics and Regenerative Medicine- What's New, What's Next

[Year:2018] [Month:April-June] [Volumn:52 ] [Number:2] [Pages:51] [Pages No:iii-v]



It is an exciting time in regenerative medicine. We are witness to an unprecedented explosion of knowledge and innovation in both basic and translational science, as well as clinical application. The great possibility of the application of biologically driven therapies holds great interest and hope from patients, practitioners, academia, and industry alike. The opportunity to cure un-curable or difficult to treat disorders and diseases captures and holds the interest of patients who are one of the key drivers for innovation.


INVITED ARTICLE
Saurabh Singh, Vijay Shetty

Critical Analysis of the Use of Platelet-rich Plasma in Orthopedic Clinical Practice: An Evolving Story

[Year:2018] [Month:April-June] [Volumn:52 ] [Number:2] [Pages:51] [Pages No:53-55]



Orthobiologics are substances that are believed to help injuries heal more quickly. Orthobiologic agents include products, such as stem cells and platelet-rich plasma (PRP) containing various (good and bad) growth factors. The use of PRP in orthopedic clinical practice and evolution of this treatment in sports medicine, over the last decade or so, is a story of innovation, experimentation, controversies, and matter of huge debate.

Keywords: Orthopedics, Platelet-rich plasma, Sports medicine.

How to cite this article: Singh S, Shetty V. Critical Analysis of the Use of Platelet-rich Plasma in Orthopedic Clinical Practice: An Evolving Story. J Postgrad Med Edu Res 2018;52(2):53-55.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Madhuresh Kumar, Santosh Kumar, Tulika Chandra, Vineet Sharma

Clinical Outcome of Intra-articular Injection of Platelet-rich Plasma in Early-stage Knee Osteoarthritis in North Indian Patients

[Year:2018] [Month:April-June] [Volumn:52 ] [Number:2] [Pages:51] [Pages No:56-61]



Introduction: With increasing frequency, platelet-rich plasma (PRP) preparations have been used to treat cartilage lesions to regenerate tissue homeostasis and retard the progression of knee osteoarthritis (OA).

Purpose: To determine the effectiveness of intra-articular PRP injections in early-stage OA patients and to evaluate the clinical outcome.

Materials and methods: This prospective study was conducted in the Department of Orthopaedic Surgery, King George’s Medical University, Lucknow, Uttar Pradesh, India. The study was conducted on patients with early-stage OA knee enrolled on outpatient department basis during the year 2014 to 2015. The effective sample size was 40 patients with bilateral OA knee in which intra-articular injection was given. And the clinical outcomes and effectiveness were measured in terms of visual analog scale and Western Ontario and McMaster Universities Osteoarthritis Index scores at the end of 6, 12, and 24 weeks. A p-value <0.05 was considered statistically significant.

Results: There was significant improvement in all scores at the end of 6, 12, and 24 weeks.

Conclusions: The PRP treatment showed positive effects in patients with knee OA.

Clinical relevance: There are only a few studies of PRP treatment for cartilage on OA knees. Different PRP products might be more or less appropriate to treat different types of tissues and pathologies. The clinical efficacy of PRP remains under debate, and a standardized protocol has not yet been established.

Keywords: Intra-articular injection, Osteoarthritic knee, Plateletrich plasma.

How to cite this article: Kumar M, Kumar S, Chandra T, Sharma V. Clinical Outcome of Intra-articular Injection of Platelet-rich Plasma in Early-stage Knee Osteoarthritis in North Indian Patients. J Postgrad Med Edu Res 2018;52(2):56-61.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Nusrat Shafiq, Samir Malhotra

Reporting of Outcomes in Clinical Trials

[Year:2018] [Month:April-June] [Volumn:52 ] [Number:2] [Pages:51] [Pages No:62-63]



Addition/deletion/modification of prespecified outcomes makes clinical trial results untrustworthy. Tackling this outcome reporting bias remains a challenge in spite of the advent of clinical trials.

Keywords: Clinical trials, Journal, Outcome reporting.

How to cite this article: Shafiq N, Malhotra S. Reporting of Outcomes in Clinical Trials. J Postgrad Med Edu Res 2018;52(2):62-63.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Sandeep Patel, Mandeep S Dhillon

Platelet-rich Plasma in Orthopedics: Efficacy, Evidence, and Evolution of Our Understanding over 10 Years

[Year:2018] [Month:April-June] [Volumn:52 ] [Number:2] [Pages:51] [Pages No:64-72]



Introduction: Platelet-rich plasma (PRP) is fast emerging as a minimally invasive treatment option in a wide variety of orthopedic conditions. We were the forerunners in India in its use in osteoarthritis (OA), lateral epicondylitis, plantar fasciitis, and sports injuries. We present our experience with prospective clinical studies and multiple research projects, and have shown some aspects to be reproducible and evidence-based, whereas some areas of application seem to demand more evidence prior to routine recommendation for use.

Materials and methods: Since 2009, PRP is in routine use at the Postgraduate Institute of Medical Education and Research (PGIMER); this ensued after our initial struggle of standardizing PRP as a product, followed by its clinical use in early OA knee, followed by use in recalcitrant tennis elbow, recalcitrant plantar fasciitis and various sports injuries. We also carried forward our PRP work with some experimental in vitro studies on anterior cruciate ligament (ACL) regeneration by PRP in a cell culture model. Our work on guinea pig OA model to compare PRP vs normal saline to document histological and biomarkers in OA is ongoing, and initial experience with that is also presented.

Conclusion: From our experience, and a meta-analysis of the literature, it can be stated that PRP is effective in early degenerative knees (as a short-term modality) and lateral epicondylitis. We also recommend its use in chronic tendinopathies and various sports injuries; however, its use in these situations needs to be limited, as there is conflicting evidence in the literature, and our work on this aspect is preliminary in nature. In the case of ACL regeneration, we found equivocal experimental findings, and more research toward this area is the necessity of the hour.

Keywords: Knee osteoarthritis, Orthobiologics, Platelet-rich plasma, Sports injury.

How to cite this article: Patel S, Dhillon MS. Platelet-rich Plasma in Orthopedics: Efficacy, Evidence, and Evolution of Our Understanding over 10 Years. J Postgrad Med Edu Res 2018;52(2):64-72.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Aditi Mahajan, Siddhartha Sharma, Shalmoli Bhattacharyya

Potential Application of Mesenchymal Stem Cells and Their Secretory Factors for Musculoskeletal Disorders: A Brief Review

[Year:2018] [Month:April-June] [Volumn:52 ] [Number:2] [Pages:51] [Pages No:73-82]



Musculoskeletal system accounts for the support, stability, and locomotion or movement of the human body. Musculoskeletal disorders (MSDs) include any injury, damage or disorder of muscles, bone, cartilage, tendons, ligaments, and joints in upper/ lower limbs or the back. Mesenchymal stem cells (MSCs) are being increasingly used for a variety of MSDs owing primarily to their excellent regenerative potential. The major mechanism through which MSCs participate in tissue repair is by the secretion of a broad repertoire of molecules which serve a myriad of biological functions. These molecules, collectively called as secretome, provide a way for cell free therapy by surpassing the limitations of cellular therapy and at the same time, provide equivalent benefits to the recipient. Cell free therapy utilizing only the secretome of MSCs has gained popularity in the past few years, and various preclinical studies have employed either the soluble factors, or vesicles, or complete secretome not only for disorders of musculoskeletal system but also of central nervous system, cardiac system, circulatory system, and autoimmunity. However, the exact mechanism of action of many of these molecules still remains to be discovered. Therefore, achieving an optimal outcome of tissue function restoration by designing a cell free therapeutic regimen using only secretome remains a major challenge. While acknowledging the potential of MSC secretome in other areas of regenerative medicine, this review will elucidate the regenerative potential of MSCs and their secretome in MSDs.

Keywords: Conditioned media, Mesenchymal stem cells, Muscle repair and regeneration, Musculoskeletal disorders, Secretome.

How to cite this article: Mahajan A, Sharma S, Bhattacharyya S. Potential Application of Mesenchymal Stem Cells and Their Secretory Factors for Musculoskeletal Disorders: A Brief Review. J Postgrad Med Edu Res 2018;52(2):73-82.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Rajesh K Rajnish, Vishal Kumar, Sarvdeep S Dhatt

Orthobiologics in Spine

[Year:2018] [Month:April-June] [Volumn:52 ] [Number:2] [Pages:51] [Pages No:83-87]



Orthobiologics are the biologically derived materials from the body to promote the repair and regeneration of muculoskeletal tissues. Orthobiologics has got special attention in recent past and become the focus of study of researchers in various traumatic and nontraumatic spinal pathologies. Efforts were made to develop materials capable of bone formation and which encourage healing of fractures. When they are used in higher concentrations than normally present in the body, they can potentially help speed up the healing process. The substances which are considered to be orthobiologics are: bone grafts, autologous blood, autologous conditioned serum (ACS), platelet-rich plasma (PRP), growth factors, and stem cells.

Various clinical and animal studies have shown variable results. This review gives an outline regarding the currently available clinical information and application of orthobiologics in various spinal pathologies for therapeutic use.

Keywords: Autologous conditioned serum, Bone graft, Bone morphogenic, Orthobiologics, Platelet-rich plasma, Spine.

How to cite this article: Rajnish RK, Kumar V, Dhatt SS. Orthobiologics in Spine. J Postgrad Med Edu Res 2018;52(2):83-87.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Sanjay Yadav, Saurabh Singh, Rohit Amar, Ramvilas Nag

Traumatic Lateral Listhesis of Lumbar Spine in a Young Female

[Year:2018] [Month:April-June] [Volumn:52 ] [Number:2] [Pages:51] [Pages No:88-89]



Traumatic lateral translation is an extremely rare presentation. The diagnosis may be easily missed. An 18-year-old female presented with fall from height and backache and weakness in bilateral lower limbs. On examination, there was tenderness in lumbar spine, step-like deformity; neurological examination revealed no sensory loss and grade III power in both lower limbs without bowel and bladder involvement. Radiographic examination showed anterolateral listhesis of L5 over S1. Magnetic resonance imaging showed spinal canal stenosis and mild compression of traversing caudal roots. Patient was treated with open reduction and stabilization with posterior instrumentation, decompression, and posterolateral fusion. Complete neurological recovery was observed over 1-year follow-up period.

Keywords: Lateral, Listhesis, Lumbar, Spine, Traumatic.

How to cite this article: Yadav S, Singh S, Amar R, Nag R. Traumatic Lateral Listhesis of Lumbar Spine in a Young Female. J Postgrad Med Edu Res 2018;52(2):88-89.

Source of support: Nil

Conflict of interest: None


PROCEEDINGS OF CONGRESS IBOSCON 2018
Sandeep Patel, Tungish Bansal, Mandeep S Dhillon, Devendra K Chouhan, Himanshu Kanwat, Alka Bhatia

Multiple PRP Injection vs Single PRP Injection in Early OA Knee: An Experimental Study in a Guinea Pig Early Knee OA Model

[Year:2018] [Month:April-June] [Volumn:52 ] [Number:2] [Pages:51] [Pages No:90-103]



Platelet-rich plasma (PRP) has emerged as the forerunner among disease-modifying treatment options of early osteoarthritis (OA) of knee.1 However, there is currently no consensus on the number and frequency of PRP injections, and their dosing schedules are widely debated. A few clinical studies2,3 have shown that multiple injections of PRP are better than single injection; however, the biological basis of this effect is not yet clear.


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