In an effort to get our valued readers closer to the Olympic games, The Orthohealing Center has teamed up with the Team USA News
. Please link to have access to the latest info and receive exclusive updates throughout the games. These athletes have dedicated their lives to this very moment & could use your support! We have treated many Olympic athletes & wish them well in the 2010 games!
The Orthohealing Center
We were thrilled to have Dr Alan Lazar an orthopaedic surgeon from Plantation Florida visit our LA center recently. Dr Lazar specializes in minimally invasive arthroscopy and uses PRP in the operating room to facilitate recovery naturally. Also he has been injecting PRP in many patients. Most interestingly, Dr Lazar is one of few doctors pioneering adult fat stem cell injections to potentially regenerate cartilage & reduce pain from osteoarthritis. Various doctors are combining adult stem cells with PRP to get maximum results. Best of luck to Dr Lazar and many thanks to our patients allowing him to observe PRP ultrasound guided procedures. 
The Orthohealing Center
ALS or Lou Gehrig’s disease is a devastating disease that affects the neuromuscular system resulting in muscle weakness with eventual difficulty swallowing and breathing. For patients suffering with this condition many of the trreatments are palliative to improve function like rehabilitation. Some of my patients in the recent past have seeked stem cell based therapies in foreign countries like Costa Rica. One patient received Bone Marrow Stem Cells along with Menstural cells which were injected into his spine. These patients termed “pioneer patients” are driving change & are increasing awareness by describing their experiences. Unfortunately his treatment was not successful. However perhaps it won’t be long before Americans won’t have to travel abroad for these procedures.
According to CNNthe first US FDA approved trial (Neuralstem) utilizing 8 week fetal tissue for stem cells is taking place. The researchers are very noble in their efforts & the patients are very brave. However these patients have little options to reverse the effects of their disease.
In a recent article in the Journal of American Medicine (JAMA), a group from the Netherlands studies PRP VS saline injections under ultrasound guidance. The patients were studied for 6 months as a preliminary report. The study showed that both groups equally improved beyond baseline. The researchers concluded that the injection was no more than a placebo effect and that the eccentric exercises that both groups performed may have caused the benefits.
It’s great that more & more evidence is emerging on PRP therapy. This study was a single center randomized blinded trial however it did have some limitations.
Here are my thoughts.
My published review article is referenced in the JAMA article. While the authors of this study should be commended by adding to a topic in need of controlled trials; there are some limitations to be mindful of before drawing indefinite conclusions.
First, there was no gel matrix added which may have limited the duration of time the PRP was in the tendon. The injection graft was activated by direct contact with the tendon upon injection without an agonist. I currently use a PRP that utilizes a gel matrix by utilizing autologous thrombin combined with calcium chloride.
Secondly there were no laboratory platelet counts performed to determine what PRP levels were achieved. There are numerous platelet separation devices available with varying concentrations of platelets & leukocytes & having definitive counts would have been insightful.
The authors unfortunately did not have a third control group to isolate the effects of an eccentric exercise program. It is unreasonable to assume that the eccentric exercises alone accounted for the substantial clinical improvement of VISA-A & satisfaction surveys in both groups. Moreover there is no discussion on the theory that the ultrasound guided needle procedure in both groups may have created microtrauma that could initiate healing.
Also there is no long term f/u beyond 6 months. Follow up in 12 months may indicate a difference between the two control groups. Also there is no follow up imaging to determine if there is structural healing occurring.
The article provides good follow up data on a single injection, however for chronic Achilles tendinosis, a series of injections may be required.
It’s terrific that more & more studies are emerging to better define how PRP is best indicated. In my experience chronic Achilles tendinosis is a very challenging condition with limited treatment options. This study suggests that needling of the injured tendon under ultrasound guidance combined with an eccentric exercise program was effective initially for 6 months. However long term follow up data & imaging is necessary to clarify interpretations. As with any treatment there will be pro & con articles. In the end we’ll continue better understand this treatment which is in no way a panacea.
Dr Steven Sampson
Last week after our visit from Japanese Orthopaedic Surgeon Dr Sobajima, we were honored to have Dr Betul Turan of Turkey visit us. Dr Turan is a Physiatrist who specializes in non-surgical orthopaedics. Her husband is an Orthopaedic surgeon who specializes in cartilage regeneration & repair. Together they are creating a state of the art Regenerative Medicine clinic in Orthopaedics. Dr Turan observed numerous cases including platelet rich plasma injections utilizing ultrasound guidance. In 2009 we had numerous Dr’s from across the world including Canada, Australia, Korea, Japan, Turkey and others observe procedures for training.
We were thrilled to have Satoshi Sobajima MD, an orthopaedic surgeon from Osaka Japan visit last week. Dr Sobajima spent time at the University of Pittsburg doing progressive research in regenerative medicine. Using stem cells, gene therapy, & PRP Dr Sobajima studied regeneration of intervertebral discs of the spine in animal models. Currently Dr Sobajima is looking at PRP & stem cells to regenerate cortical bone in Rabbit Femurs. This research could potentially influence surgical protocol around the world as we look for more cost effective, safer, and natural based alternatives. Dr Sobajima will be presenting his data at the Regenerative Medicine conference in Hiroshima in March 2010. Dr Steven Sampson will also be discussing his knee arthritis study and PRP experiences in Japan.
Dr Sobajima was particularily interested in utilizing ultrasound guidance for his non surgical management of orthopaedic issues. We welcome Dr’s from around the world to visit here to observe our work & to collaborate on research projects in the future.
On Nov 26, 2009 pioneering physicians from around the world will meet in London to form a consensus statement on the use of complex growth factors to treat muscle & tendon injuries. The UKA or United Kingdom Athletics is the national governing body for athletics, including the Olympics & P
aralympics.
Dr Steven Sampson was invited to participate to share clinical experience with PRP. After the symposium, hopefully a consensus statement will be published. PRP has seen increased use in professional sport. Having meetings like this is paramount to advance our understanding of the potential role for growth factors & biologics in sport.
Congratulations to our patient who rallied to beat a tendon injury & raised money and awareness to support research for Multiple Sclerosis. MS affects many Americans and can cause significant disability. However with progressive research doctors are coming up with new approaches including stem cell therapies to change the way we are thinking about this condition.
Shoulder Injection Ultrasound demonstration
Dr Steven Sampson was featured in a new iPhone application to teach Doctors across the world how to begin using ultrasound to enhance their practice. Ultrasound is used commonly in Europe, but suprisingly is only now seeing increased use. Ultrasound provides remarkable images of tendons and ligaments and soft tissue in some cases superior to MRI. Also Ultrasound is extremely cost effective compared to other imaging like MRI. Thus by utilizing state of the art technology our health care system could save millions of dollars. “Pioneer patients” are driving awareness to doctors who will have to meet the demand for more cutting edge treatents & imaging to help them recover and heal.
Danielle Aufiero MD, specializes in non-surgical orthopaedics at the Orthohealing Center in Los Angeles, CA.
Danielle Aufiero MD Describes the Orthohealing Center in a new video.
