PRP and BMAC for Musculoskeletal Conditions via Biomaterial Carriers
Abstract
:1. Introduction
2. Platelet-Rich Plasma (PRP)
3. Bone Marrow Aspirate Concentrate (BMAC)
4. Biomaterials
4.1. Collagen
4.2. Hyaluronic Acid (HA)
4.3. Poly (Lactic-Co-Glycolic) Acid (PLGA)
4.4. Cartilage
5. Conclusions
Funding
Conflicts of Interest
References
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Tissue | Study | System | Anticoagulant | Classification * | Findings |
---|---|---|---|---|---|
Cartilage | Sanchez et al., 2008 [25] | Manual 640× g/8 min | Sodium citrate | II1 | (+) significant improvement of pain |
Kon et al., 2010 [26] | Manual 1800 rpm/15 min 3500 rpm/10 min | Sodium citrate | IIB1 | (+) reduction of pain and improvement of knee function in younger patients with low degree of articular degeneration | |
Kon et al., 2011 [27] | Manual 1480 rpm/6 min 3400 rpm/15 min | DNS | IIB1 | (+) PRP greater and longer efficacy than HA injection | |
Lee et al., 2013 [28] | Magellan Autologous Platelet Separator (Medtronic Biologic Therapeutics and Diagnostics) | Sodium citrate | IB2 | (+) significant improvement in clinical results in early OA. | |
Patel et al., 2013 [29] | Manual 1500 rpm/15 min Leukocyte filtered | Citrate phosphate dextrose | PRP-IIA1 | (+) effective to alleviate symptoms in early knee OA | |
Duif et al., 2015 [30] | ACP-system (Arthrex) 1500 rpm/5 min | DNS | 2 | (+) pain reduction, gain knee function | |
Filardo et al., 2015 [31] | Manual 1480 rpm/6 min 3400 rpm/15 min | DNS | Red-L-PRP-IIB1 | (=) PRP do not provide a superior clinical improvement when compared to HA | |
Sanchez al, 2016 [32] | Manual 580× g/8 min | Sodium citrate | PRP-IIA1 | (+) multiple injections of PRP are useful in achieving better clinical results in early OA | |
Gormeli et al., 2017 [33] | Manual 1500 rpm/6 min 3500 rpm/12 min | DNS | Red-L-PRP-IIB1 | (+) multiple injections of PRP are useful in achieving better clinical results in early OA | |
Kaminski et al., 2018 [34] | DNS | DNS | II | (+) increased meniscus repair | |
Kaminski et al., 2019 [35] | Manual 900 rpm/9 min 3200 rpm/15 min | DNS | IIB1 | (+) significant improvement in the rate of chronic meniscal tear healing | |
Bone | Marx et al., 1998 [36] | Manual 5600 rpm and 2400 rpm | Citrate Dextrose | Red-L-PRP-IIB1 | (+) enhanced bone graft in mandibular fracture |
Rodriguez et al., 2003 [37] | Smart Prep (Harvest Technologies) | DNS | II2 | (+) effective in maxillary sinus augmentation | |
Daif et al., 2012 [38] | Manual 1200 rpm/20 min 2000 rpm/15 min | Sodium citrate | Red-L-PRP-IIB1 | (+) enhanced bone regeneration in mandibular fracture | |
Anitua et al., 2015 [39] | Manual 580× g/8 min | Sodium citrate | I1 | (+) enhanced healing of extraction socket | |
Malhotra et al., 2015 [40] | DNS | DNS | PRPIB | (+) fracture healing acceleration in nonunion fractures | |
Tabrizi et al., 2015 [41] | Manual 800× g/5 min 1500× g/5 min | Citrate phosphate dextrose | II1 | (+) enhanced bone formation in bone cavity | |
Ghaffarpasand et al., 2016 [42] | Gravitational Platelet Separation System (GPS III; BIOMET) 3200 rpm/15 min | Acid-citrate dextrose | B2 | (+) higher cure rate and less pain in non-union fractures | |
Castillo-Cardiel et al., 2017 [43] | PRGF System III (BTI) 450× g/8 min | Sodium citrate | II2 | (+) increase of bone intensity and density in mandibular fractures | |
Acosta-Olívio et al., 2017 [44] | Manual 1800 rpm/5 min 3200 rpm/3 min | Sodium citrate | II1 | (+) earlier bone consolidation in shaft fractures | |
Muscle | Hamid et al., 2014 [45] | GPS III | DNS | Red-L-PRP-IIB2 | (+) PRP combined with rehabilitation program was more effective in treating hamstring injuries than rehabilitation program alone |
Hamilton et al., 2015 [23] | GPS III 3200 rpm/15 min | Citrate dextrose | Red-L-PRPIB2 | (−) no benefit of PRP injection compared to rehabilitation in athletes | |
Reurink et al., 2015 [24] | ACP-system | EDTA | PRP-IA2 | (−) no benefit of PRP injections compared with placebo in patients with acute hamstring | |
Bubnov et al., 2016 [46] | Manual DNS | DNS | 1 | (+) injections of PRP under ultrasound guidance had higher level of pain relief, physical recovery, and faster regeneration compared with conventional conservative treatment in acute muscle trauma in professional athletes | |
Martinez-zapata et al., 2016 [47] | Platelet apheresis | DNS | PRP-IIB3 | (−) PRP did not improve the time to healing compared to that in the control group | |
Rossi et al., 2017 [48] | Manual 1400 rpm/3 min 3000 rpm/4 min | EDTA | I1 | (+) PRP injection combined with a rehabilitation program me shortened time to return to sports compared to a rehabilitation programme only |
Tissue | Study | BMAC preparation | # Progenitor Cells Injected | Follow-up | Findings |
---|---|---|---|---|---|
Cartilage | Kim et al., 2014 [58] | SmartPReP2 Bone Marrow Procedure Pack BMAC2 kits (Harvest Technology) | DNS | 12 months | (+) 41 patients injected with BMAC. VAS showed significant pre- to postoperative improvement. All functional scores were increased after the procedure. Better outcomes were obtained in early to moderate stages of OA than more advanced stages. (OA of the knees) |
Shapiro et al., 2016 [60] | Filtered 170 µm Magellan Autologous Platelet Separator System (Arteriocyte) | MSC = 3.44 × 104 HSC = 4.62 × 106 | 6 months | (=) 25 patients, 13 were injected with BMAC in their right knee and placebo in the left knee and 12 received the opposite. No differences were observed between placebo and treated knee. (OA of the knees) | |
Desandis et al., 2017 [64] | DNS | DNS | 16.7 months | (+) 46 patients treated with JACI–BMAC were retrospectively evaluated. The mean questionnaire SF-12v2 and FAOS improved significantly from pre- to postoperatively. Of the 46 patients in the study, 22 had postoperative MRI scans that could be scored. MOCART score was 46.8. (Osteochondral Lesions of the Talus) | |
Shapiro et al., 2018 [61] | Filtered 170 µm Magellan Autologous Platelet Separator System (Arteriocyte) | MSC = 3.44 × 104 HSC = 4.62 × 106 | 12 months | (=) 25 patients, 13 were injected with BMAC in their right knee and placebo in the left knee and 12 received the opposite. BMAC did not show superior results compared to saline group. (OA of the Knees) | |
Themistocleous et al., 2018 [59] | 2800 rpm/15 min | DNS | 11 months | (+) 121 patients treated with BMAC were retrospectively evaluated. NPS decreased 8.33 preoperatively to 4.49 postoperatively (p < 0.001). The mean Oxford knee score (OKS) increased from 20.20 pre-operatively to 32.92 postoperatively (p < 0.001). (OA of the Knees) | |
Karnovsky et al., 2018 [63] | Magellan Autologous Platelet Separator (Anteriocyte Medical Systems) | DNS | 28.1 months | (−) 30 patients treated MF and 20 who received JACI-BMAC were retrospectively evaluated. Both treatments showed significant pre- to postoperative improvements in all FAOS subscale. MF showed a significant improvement in VAS. Average osteochondral lesion diameter was significantly larger in JACI-BMAC group compared to MF group. (Osteochondral Lesions of the Talus) | |
Bone | Hernigou et al., 2002 [65] | Cell separator (Cobe 2991) 400× g/5 min | CFU-F = 25 × 103 cells | 7 years | (+) 116 patients (189 hips) injected with BMAC after core decompression with a small trocar. Total hip replacement was needed in 34 hips (22 patients) among 189 hips treated. Patients with a higher number of progenitor cells transplanted had better outcomes (ONFH) |
Hernigou et al., 2005 [66] | Cell separator (Cobe 2991) 1200× g/5 min | CFU-F = 5.1 × 104 cells Progenitors = 5.49 × 104 (53 patients) 1.93 × 104 (7 patients) | 4 months | (+) Bone union was obtained in 53 of the 60 patients that received the higher number of progenitor cells. The BMAC efficacy is related to the number of progenitors in the graft. (Nonunions) | |
Tabatabaee et al., 2015 [67] | Bone marrow was filtered and washed. Then was centrifuged for 400g/5–10 min | NC = 4.76 × 103 cells | 24 months | (+) 28 hips were randomized in 2 groups of core decompression with and without BMAC. The mean WOMAC and VAS scores in all patients improved significantly (p < 0.001). MRI showed a significant improvement in group treated with BMAC (p = 0.046) and significant worsening in the non-treated group (p < 0.001). (ONFH) | |
Hauzeur et al., 2018 [68] | Spectra cell separator (777,006,300; Cobe) | NC = 3.46 × 109 cells CFU-F = 3.46 × 106 NC | 24 months | (=) Double blind RCT study comparing two groups: core decompression plus saline injection or core decompression plus BMAC implantation. Both groups included 19 patients (23 hips). No differences were observed between groups for THR requirements, clinical evaluation and radiological evolution. In both groups, 15/23 hips needed THR. (ONFH) |
Tissue | Study | Biomaterial | Formulation | Preparation (PRP/BMAC) | Follow-up | Findings |
---|---|---|---|---|---|---|
Bone | Dallari et al., 2007 [103] | Bone Chip | Scaffold | PRP/BMAC | 1 year | (=) No significant difference between PRP/BMAC groups and empty lyophilized bone controls as all patients reported relieved knee pain and full range of motion. |
Sauerbier et al., 2010 [106] | Bovine Bone Mineral | Particles | BMAC | 4 months | (=) New bone formation was 19.9% but not significantly different from the synthetic polysaccharide isolation method control. | |
Jager et al., 2011 [104] | Collagen | Sponge | BMAC | 1 year | (+) Radiography showed significant bone remodeling in all groups, but healing was longer when compared to BMAC/hydroxyapatite controls. | |
Yassibag-Berkman et al., 2007 [107] | β-TCP | Slurry | PRP | 1 year | (=) No significant difference between clinical parameters in PRP and control groups | |
Attia et al., 2010 [108] | β-TCP | Slurry | PRP | 1 year | (+) Significant reduction of probing depth and increase in clinical attachment gain (p < 0.01) | |
Saini et al., 2011 [109] | β-TCP | Slurry | PRP | 9 months | (+) Significant decrease in pocket depth and increase in clinical attachment (p < 0.05) in β TCP/PRP compared to β TCP alone | |
Özdemir et al., 2012 [110] | β-TCP | Slurry | PRP | 6 months | (=) All 6 parameters evaluating clinical outcome were not significant between PRP and control groups (p < 0.05) | |
Okuda et al., 2005 [111] | HAp | Scaffold | PRP | 1 year | (+/−) There were significant differences in gingival index, bleeding on probing, probing depth and clinical attachment level, in PRP groups compared baseline (p < 0.001), and significant differences in PRP versus control groups in probing depth, clinical attachment gain, and vertical attachment (p < 0.05) No significant difference in defect change between PRP scaffolds versus saline scaffolds, however, positive significant gain was seen compared to baseline measurements (p < 0.01) | |
Vaishnavi et al., 2011 [112] | HAp | Scaffold | PRP | 1 year | (=) Radiographic evaluation showed bone regeneration in all groups (scaffold, PRP, scaffold with PRP) except the negative control | |
Menezes et al., 2012 [113] | HAp | Scaffold | PRP | 4 years | (+) Significant differences in defect fill were seen in PRP/hydroxyapatite treated group compared to hydroxyapatite/saline control (p < 0.001) | |
Kutkut et al., 2012 [114] | MGCSH | Scaffold | PRP | 3 months | (+) Radiographic evaluation confirmed more dense bone in MGCSH and PRP groups compared to empty MGCSH, and histomorphic analysis showed a statistically significant difference between these groups (p < 0.05) | |
Cartilage | Siclari et al., 2012, 2014 [81,115,116] | PLGA-HA | Matrix | PRP | 1–5 years | (+) Histology showed homogenous repair tissues and good integration of repair tissues to the subchondral bone and adjacent cartilage and immunohistochemistry showed signs of hyaline like cartilage formation. At 2 years, hyaline-to hyaline cartilage repair tissue that was rich with a chondrocyte morphology, proteoglycans, and type-II collagen. At 4 years, MRI confirmed good defect and volume filling in 20 of 21 patients and received high MOCART scores. |
Siclari et al., 2018 [117] | PLGA-HA | Matrix | PRP | 2 years | (+) AOFAS rating increased significantly (p < 0.01). ROM increased significantly (p < 0.01). | |
Enea et al., 2013 [118] | PLGA-HA | Matrix | BMAC | 2 years | (+) MRIs showed all patients had complete defect and volume filling and resurfacing of articular cartilage to previous cartilage level. Some bone marrow edema and subchondral irregularities were observed—as well subchondral irregularities. | |
Giannini et al., 2009 [119] | HA | Membrane | BMAC | 2 years | (+) MRI done 12 months postoperatively showed tissue regeneration in all 48 patients. Integration with the healthy cartilage was complete, and transition zones were smooth in all patients. Immunohistologic results confirmed new cartilaginous tissues with varied hyaline cartilage tissue remodeling. | |
Buda et al., 2010 [120] | HA | Scaffold | BMAC | 2 years | (+) Post-treatment IKDC and KOOS scores were significantly higher than pre-treatment (p < 0.0005). MRIs taken at 1 and 2 years after treatment shown subchondral bone and cartilage regeneration. Histological analysis showed a proteoglycan rich matrix and collagen II throughout the regenerated tissue. | |
Gobbi et al., 2016 [121] | HA | Scaffold | BMAC | 5 years | (+) All HA-BMAC scaffold treated patients maintained classification as normal or nearly normal by IKDC, KOOS, Tegner, and Lysholm. No quality of repair studies were done in this study. | |
Gobbi et al., 2017 [122] | HA | Scaffold | BMAC | 4 years | (+) KOOS, IDKC, Tegner, and VAS scores were significantly improved in both the over and under 45 year-old groups. MRI determined 80% defect filling in the over 45 group and 71% defect filling in the under 45 group, and histology on 3 and 2 patients from these groups, respectively, showed good tissue repair with varying amounts of hyaline-like tissue. | |
Dhollander et al., 2011 [123] | Collagen | Scaffold | PRP | 2 years | (+) VAS, Tegner, Kujala patellofemoral, and KOOS scores showed improvement. MRI data showed incomplete filling in 3/5 patients, hypertrophy in 2/5 patients. Complete integration with adjacent was observed in all patients, but the surface of the repair tissue was irregular in all patients during 1 year and 2 year post-operative scans. MOCART scores remained stable during the 2 year period. | |
Enea et al., 2015 [124] | Collagen | Membrane | BMAC | 2 years | (+/−) Significant (p < 0.05) IKDC subjective score improvement, Lysholm score, VAS, and activity level pre vs. post-operative, but no change in Tegner score. MRI scans taken between 6–9mo after surgery showed reconstitution of original cartilage levels, bone marrow edema and/or subchondral; irregularities for all cases. Histologically, only 1/5 had hyaline-like matrix, and that matrix did not exhibit cell arrangements of normal articular cartilage. | |
Gigante et al., 2012 [82] | Collagen | Membrane | BMAC | 2 year | (+) Full weight bearing in 6 weeks, jogging at 6 months, continuously asymptomatic at 24 months. MRI scan at 12 months showed good defect filling with tissue signal signals similar to that or surrounding tissue without signs of bone marrow edema. | |
Gigante et al., 2011 [125] | Collagen | Scaffold | BMAC | 1 year | (+/−) All 5 patients self-reported themselves as asymptomatic. Mean histological scores of 59.8(SD 14.5). 1 had hyaline-like cartilage,3 had hyaline/fibrocartilage, and 1 had fibrocartilage formation. Columnar structures of normal articular cartilage were not observed in any case. | |
Giannini et al., 2013 [126] | Collagen | Scaffold | BMAC | 4 years | (+/−) AOFAS score improved significantly (p < 0.0005) at 24mo, but decreased significantly between 24mo and 36mo (p < 0.001), and 24mo to 48mo (p < 0.005). MRI T2 mapping analysis showed that regenerated tissue has similar values to that of hyaline cartilage −9/20 had complete defect filling and 13/20 had tissue integration at the border zone. However, a majority of patients also had damaged subchondral lamina, disrupted subchondral bone, and subchondral edema. | |
Gobbi et al., 2011 [127] | Collagen | Matrix | BMAC | 2 years | (+) Visual analog scale (VAS), IKDC, KOOS, Lysholm, Marx, SF-36, and Tegner scores all showed significant improvement after the final follow-up of 15 patients (p < 0.005). MRI T2 and histology showed hyaline like cartilage formation and complete defect filling of 12 of 15 patients with no signs of hypertrophy. Integration with adjacent cartilage was complete in 14 of those same patients. | |
Krych et al., 2016 [105] | PLGA | Scaffold | PRP/BMAC | 1 year | (+) No subjective clinical outcome measures were included in 11 control patients, 23 PRP treated patients, and 12 BMAC treated patients. PRP and BMAC patients both had significantly (p < 0.002, p < 0.03) better fill than the control and was more hyaline like as determined my MRI T2 mapping. | |
Skowronski et al. 2013 [128] | Collagen | Membrane | BMAC | 5 years | (+) An improvement was observed in 52 out of 54 patients in all scales (KOOS, Lysholm, VAS, KOOs pain) after comparison between Preoperative and 12 months post-operatively. No differences were observed between 12 months and 5 years after surgery. |
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Yamaguchi, F.S.M.; Shams, S.; Silva, E.A.; Stilhano, R.S. PRP and BMAC for Musculoskeletal Conditions via Biomaterial Carriers. Int. J. Mol. Sci. 2019, 20, 5328. https://doi.org/10.3390/ijms20215328
Yamaguchi FSM, Shams S, Silva EA, Stilhano RS. PRP and BMAC for Musculoskeletal Conditions via Biomaterial Carriers. International Journal of Molecular Sciences. 2019; 20(21):5328. https://doi.org/10.3390/ijms20215328
Chicago/Turabian StyleYamaguchi, Fabio S. M., Shahin Shams, Eduardo A. Silva, and Roberta S. Stilhano. 2019. "PRP and BMAC for Musculoskeletal Conditions via Biomaterial Carriers" International Journal of Molecular Sciences 20, no. 21: 5328. https://doi.org/10.3390/ijms20215328