Knee osteochondritis and platelet rich plasma
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This document discusses the use of platelet-rich plasma (PRP) in treating osteochondritis dissecans (OCD) and other knee lesions in young athletes, detailing a case study of a 13-year-old hockey player who benefited from PRP after unsuccessful conservative treatments. It reviews the history, pathology, and management of OCD, emphasizing that while PRP shows promise in enhancing healing, evidence regarding its efficacy and long-term safety is still limited. The findings suggest that PRP could be beneficial for young patients, but more research is needed to fully validate its effectiveness.
Knee osteochondritis and platelet rich plasma
- 1. The use of PRP in Osteochondritis dissecans and other lesion of the knee in young athletes : Does it realy work? R.Elbaum, M, Hallez, G.Dehaspe CHIREC Orthopaedic Group Hôpital DELTA Hôpital de Braine L’ALLEUD Service de Kinesithérapie Hôpital IRIS-SUD Faculté des Sciences et de la Moticité (ULB ERASME)
- 2. I have no disclosure
- 3. Introduction
- 5. Case report 13 Year old female Hockey player++ Knee pain and locking since 12 mth MRI: osteochondritis medial condyle Conservative treatment for 6 mth without any progress MRI at 6 mth:no evolution 02/2011 Surgical treatment with PGRF MRI 6mth postop Last FU 05/2014 no complaint,full mobility MRI 15/09/2011
- 6. Osteochondritis dissecans of the knee(OCD) In 1870,Paget published the first classical description of the disease Koenig in 1888,initially named the disorder « osteochondritis dissescans of the knee » Osteochondritis dissecans (OCD) is a pathological condition that results in destruction of subchondral bone with secondary damage to overlying articular cartilage. Paget J. On the production of some of the loose bodies in joints. St Bartholomews Hosp Rep 1870;6:1
- 7. OCD Classification A Dipaola JD, Nelson DW, Colville MR. Characterizing osteochondral lesions by magnetic resonance imaging. Arthroscopy 1991;7:101-4
- 8. MRI is the best choice Osteochondritis dissecans of the knee in children A comparison of MRI and arthroscopic findings M. A. O’Connor, M. Palaniappan, N. Khan, C. E. Bruce JBJS VOL. 84-B, NO. 2, MARCH 2002
- 9. OCD in young patient • Juvenile and adolescent type • Sport related • Not always symptomatic • Anterior knee pain • swelling • lockage • Medial condyle 75-80% • Bilaterality 25% Bedouelle J. L’ostéochondrite disséquante des condyles fémoraux chez l’enfant et l’adolescent. In: Cahiers d’enseignement de la SOFCOT. Paris: Expansion Scientifique Française; 1988. p. 61-93
- 10. Repetitive strain injury Vascular factors or localized ischemia Hereditary or endocrine factors Morphological anomalies Pathogeny of OCD in young patient Federico DJ, Lynch JK, Jokl P. Osteochondritis dissecans of the knee: a historical review of etiology and treatment. Arthroscopy 1990 Enneking WF.Clinical musculoskeletal pathology. Gainesville: Storter Printing; 1977
- 11. If young child and stable lesion (MRI criteria) Conservative treatment Adapted activity OCD in young patient Therapeutical approach
- 12. At adolescence if : unstable lesion failure of conservative treatment Fragment fixation Transchondral drilling Extraarticular drilling under arthroscopic control Fragment Ablation + Drilling mosaicplasty PRP, Cartilage graft ??? OCD in young patient
- 14. PRP and Osteochondritis dissecans and other lesion of the knee in young athletes
- 16. Platelet-Rich Plasma (PRP): What Is PRP and What Is Not PRP? Robert Marx 1998 IMPLANT DENTISTRY Vol. 10 No. 4 2001 y Lippincott Williams & Wilkins Printed in U.S.A.
- 17. PRP,GPS,GPRF… What it is??? Platelet-rich plasma is a serum obtained by centrifugation of autologous blood. It is defined by the American Red Cross as a blood derivative with a platelet concentration above the physiological norm.
- 18. PRP,GPS,GPRF… What it is??? Injections of PRP increase the concentrations of platelet GF in loco, leading to proliferation of fibroblasts, secondarily promoting tissue scarring. Platelets, by locally releasing their growth factors (PDGF, IGF-1, TGF-β, VEGF, bFGF ...), have a positive effect on the healing of various organic tissues.
- 20. Plasma Rich in Platelet(PRP) How does it work? "Regenerative therapy" (tissue replacement, GF, cytokines, biomaterials, stem cells ...) GF contained in the blood can act favorably on healing processes. A high concentration of GF in the blood can stimulate the healing and regeneration process of damaged joint cartilages. BUCKWALTER, J. A., and H. J. MANKIN. Articular cartilage: degeneration and osteoarthritis, repair, regeneration, and transplantation.
- 21. PRP in medicine • Neural regeneration (Peripheral nerve regeneration and Central nervous system Diseases) • Ophthalmology (Corneal persistent epithelial defects and ocular burns) • Cardiovascular therapy (Refractory angina ,Bypass graft surgery and/or aortic surgery Post-myocardial infarction remodeling) • Dermatology (Burns, Ulcers ) • Cosmetic and plastic surgery (Facial rejuvenation ,Surgical intervention ,Dermal augmentation ) • Endodontics Periapical tissue regeneration • Cell delivery and regenerative medicine • …. In “Perspectives and challenges in regenerative medicine using plasma rich in growth factors » Eduardo Anitua a,b, Mohammad H. Alkhraisat b, Gorka Orive b, Journal of Controlled Release 157 (2012) 29–38⁎ Platelets and wound healing. Nurden AT, Nurden P, Sanchez M, Andia I, Anitua E. Front Biosci 2008; 13:3532-48.
- 22. PRP in Bone @Joint surgery Cartilaginous lesions (osteochondritis, chondropathy ...) Osteoarthritis Pseudarthrosis and delayed consolidation Tendon @ ligament Muscular
- 23. PRP in Bone @Joint surgery
- 24. PRP in Bone @Joint surgery o Kaux JF, Degrave N, Crielaard JM. Platelet rich plasma : traitement des tendinopathies chroniques ? Revue de la littérature. Journal de Traumatologie du Sport 2007; 24 (2): 99-102. o de Mos M, van der Windt AE, Jahr H, van Schie HT, Weinans H, Verhaar JA, et al. Can Platelet-Rich Plasma Enhance Tendon Repair? A Cell Culture Study. Am J Sports Med 2008 Mar 7. o Fortier, L., Barker, J., Strauss, E., McCarrel, T., The Role of Growth Factors in Cartilage Repair, Clin. Orthop. Relat. Res., 2011 o Patel, S., Dhillon, M., et coll., Treatment With Platelet-Rich Plasma Is More Effective Than Placebo for Knee Osteoarthritis., The American Journal of Sports Medecine, 2013 o Kon, E., Filardo, G., Di Martino, A., Marcacci, M., Platelet-rich plasma (PRP) to treat sports injuries: evidence to support its use. Sports Medecine, 2011 o Marmotti, A., Rossi, R., Castoldi, F., Roveda, E., Michielon, G., Peretti, G., PRP and Articular Cartilage: A Clinical Update., BioMed Research International, Volume 2015 o ….
- 25. PRP in young Patient (Pubmed) A new way to treat forearm post-traumatic non-union in young patients with intramedullary nailing and platelet-rich plasma; A. Memeo a , et all Injury, Int. J. Care Injured 45 (2014) 418–423 Platelet-rich plasma for open meniscal repair in young patients: any benefit? N1, Salle De Chou E, Boisrenoult P, Beaufils P.Knee Surg Sports Traumatol Arthrosc. 2015 Jan;23(1) Caution urged in using PRP or stem cells to treat young athletes' injuries of Miami Miller School of Medicine 05/2017 Platelet-Rich Plasma Therapy for Osteochondritis Dissecans Mourad Mekaouche, MD, Samia Bekairi, MS, Mustapha Merabet, MD, Houari Koriche, MD Journal of Prolotherapy. 2017;9:e978-e981. Evaluation de l’intérêt de l’injection de plasma riche en plaquettes (PRP) dans le traitement de l’ostéochondrite des condyles fémoraux médiaux de l’enfant et l’adolescent * Etude pilote multicentrique SOFOP (2014) …. Not start yet
- 26. Our Serie 14 case files available (2011- 2015) 16 Knees OCD, patellar OC, FP or P chondropathy … Age 11-16 years 9F / 5M PRP kit used (Biomet *, Belgafix *, Adler) failure of conservative treatment Age at PRP injection: 14y+/- 1y Exclusion criteria: closed physis, LCA or meniscal tears
- 27. PATIENTS Pathologie PLAINTES SPORT IRM PREO P AGE OP Technique op C.V. OCD gr 2 D+/Blocage Danse 13A8m FEA/PRP IS V.C. CP FP 2/MI D+ >12M Gym 12A Shaving/ PRP IA V.P OCD gr3 D+/Blocage Hockey 16A FEA/PRP IS B.A. OCD gr 3 Blocage++ Danse 14A6M FEA/PRP IS D.L. OCD gr5 D+/Blocage Football 13A6M Shaving/ Forage/PRP J.E. CP apicale D++ Football 14A Shaving/PRP H.J. CP FP+apexite D++/Instabilité Education sportive 13A Shaving/PRP G.V. OC P gr 4 Gft/Blocage Hockey 14A6M Exerese/PRPShaving D.C Ca++ apicale Gft/D+ Football 14A6M Exerese/PRPPeignage F.N. CP FP3 Gft/D+/Instabilité Tennis 14A8M Release/PRP A.S CP FP 2 Gft++/D++ Hockey 15A6M IA PRP
- 28. Material @Method 0 2 4 6 8 OCD CHONDROPATHY JUMPER KNEE Knee pathology and sport related FOOTBALL HOCKEY DANSE GYM TENNIS Nombre de genoux Age Entrainements/Semai ne Heures de sport Moyenne 14 14,22 3,45 5,09 Ecart type / 1,03 1,75 2,8
- 29. Material @Method Prélèvement sanguin autologue Centrifugation du sang Récupération du PRP Injection locale IA IC IL
- 31. Material@Method 0 10 THERAPEUTICAL APPROACH Série 1 0 5 10 BELGAFIX BIOMET ARTHREX TYPE OF PRP Série 1
- 32. Result on EVA RTS @MRI T0 : Injection PRP T1 : 1 mois Premier contrôle T2 : 2 mois Deuxième contrôle T3 : 6 mois Troisième contrôle T4 : 1 an Quatrième contrôle
- 33. Result on EVA Score Moyenne Ecart type N T0 5,91 1,868 11 T1 3,27 2,687 11 T2 2,18 2,272 11 T3 1,45 2,382 11 T4 0,91 2,386 11 0 2 4 6 8 10 T0 T1 T2 T3 T4 SCORE EVA ( /10) TEMPS Evolution score EVA en fonction du temps
- 34. Result on RTS (Return to sport) Moyenne Ecart type T0 0,000 0,000 T1 0,136 0,081 T2 0,264 0,273 T3 0,609 0,324 T4 0,818 0,279 0% 50% 100% T0 T1 T2 T3 T4 %AGE DE REPRISE TEMPS Evolution du pourcentage de la reprise de l'activité sportive en fonction du temps
- 35. Result on MRI 90% cases: improvement or complete healing of the lesion in 6 mth
- 36. Case 1 Ơ 13Y6M Soccer MRI 09/2013:OCD St 5
- 38. « On retrouve les remaniements de la corticale sous-chondrale intéressant le condyle interne au voisinage de l'échancrure. Actuellement la spongieuse adjacente à ce foyer lésionnel séquellaire est sans particularité. Le cartilage à ce niveau est le siège une hypertrophie compensatoire discrètement hétérogène. Le magma cartilagineux est en continuité avec le cartilage adjacent. Ces éléments témoignent donc en première hypothèse d'une évolution favorable. » MRI 03/2014
- 39. Case 2 Ϙ 15Y Ballet MRI 09/2013 OCD type 3
- 40. EA Drilling+ PRP
- 41. Case 3 Ơ 14y6m Hockey++ OCD type 2 to type 3 L Knee MRI 02/2014 MRI 06/2014
- 42. Par rapport à l'IRM du 20/06/2014, aspect stable de la lésion ostéochondrale à la partie postéro-inférieure du condyle interne, avec discrète régression de l'oedème moelle osseuse et de la tuméfaction intra-articulaire. 4 MONTH POST INTRA CONDYLE INJECTION
- 43. Case 4 Ϙ 13Y Dancer/Karate MRI 09/2014 CP Gr 4
- 44. Shaving + PRP MRI 09/2015
- 45. Case 5 Ơ 14Y Hockey CP st 4 L Knee
- 48. Conclusion "Despite the media attention and perceived benefits of these therapies, there are still limited data as to efficacy and long-term safety. The involvement of clinicians, scientists and ethicists is essential in our quest for the truth.“ • Thomas M. Best et all. in Not Missing theFuture. Current Sports Medicine Reports, 2017
- 49. Conclusion: PRP can be used in young athletes? Why not ... but Natural History No randomized studies No real CI Advantage??? Remodeling and faster healing in young patients Lack of largest series
- 50. THANK YOU