Cornell University College of Veterinary Medicine PRP enhancement of OLT treatment. Lisa A. Fortier, DVM, PhD, DACVS James Law Professor of Surgery laf4@cornell.edu Disclosures: Arthrex Consultant, VRN Consultant, Scientific Board Kensey Nash
Disclosures • Consultant: Arthrex, Veterinary Recommended Nutraceuticals, TissueGen • Royalties: Arthrex • Scientific Board: Kensey Nash
What does the literature say? LOE Pathology Biologic Follow- Message Citation up V OLT PRP BMC NA In vivo and in vitro Smyth WJO 2012 support II OLT (32) 3PRP:3HA 6 mo PRP & HA helped Mei-Dan AJSM PRGF leuco lo nonop PRP>HA 2012 IV various PRP NA inconclusive Viannini F&A Surg 2014 II OLT (40) 1PRP:1HA:1saline 11-25 PRP &HA helped Gormelli F&A Int leuco hi mFx mo PRP>HA 2015 II OLT (35) ±PRP 12-24 PRP improved fxn Guney KSSTA 4ml leuco hi buffered mFx mo 2015 II OLT (44) ±PRP: AOTS 12-84 All improved Guney KSSTA 4ml leuco hi buffered mFx mo AOTS>mFx 2016 20% mFx reop II OLT, OCD PRP or HA NA It’s working Jazzo, J Sport Rehab 2017
Put down your awl! AJSM 2009 Gianakos Arthroscopy 2016 Small is better, but damage inevitable
Burn no bridges moderate echo time FSE A: subchondral bone B: cartilage C: fibrocartilage D: subchondral sclerosis Central osteophyte Fat supressed spoil gradient MRI Courtesy, T Mosher Courtesy, John Kennedy McIlwraith, Arthroscopy 2011
Why use PRP in OLT treatment? • Growth factors • Recruiting stem cells • Joint homeostasis – Increase lubrication (HA) – Decrease pain (TNF, NFK-B) – Decrease degradation (MMP-13)
WBCs: Good or Bad? • Buffy coat PRP - more platelets & more WBC’s – GPS, Biomet – Smart Prep, Harvest Terumo – Angel, Arthrex – Magellan Arteriocyte • Plasma PRP - low platelets & low WBC – Sanchez PRGF – Cascade (MTF) – ACP Arthrex • pH advantage blood 7.2 ACD 5.0 PRP from ACD 6.1
BMC for OAT? • 72 patients OAT with BMAC with mean 28 months FU – Improved T2 mapping Courtesy, Kennedy Kennedy et al. Cartilage 2011 } 50uM Buckley et al, J Biomech 2008, 2010
IL-1ra / Orthokine / IRAP
Bioactive factors from platelets combat biofilm infections and antimicrobial recalcitrance Gilbertie JM, Schnabel LV, Schaer TP https://schnabellab.cvm.ncsu.edu F o rm u la tio n s 1 0 d d 8 c lo g C F U /m L a 6 b S. aureus ATCC 25923 4 + WBC - WBC 2 0 A B X P P P L -P R P P R P N O N E
Activation or lysis of platelets increases efficacy In c re a s e d P o te n c y S. aureus ATCC 25923 1 0 e e 8 d lo g C F U /m L 6 a 4 b - WBC 2 c 0 A -P R P A B X P P P P R P P R P -L N O N E
PRP-L is effective against multiple arthrotropic isolates M u ltip le Is o la te E ffic a c y 1 0 d d d c d c 8 c lo g C F U /m L a S . a u re us c 6 a S . zo o e p id e m icus a a E . co li 4 b P . a eru gino sa b b 2 b 0 P R P P R P -L P P P N O N E
Which one is best for OLT? Biologic Growth Contain MSC Recruit MSC Antimicrobial Bone? factors PRP + - + + BMC + + + ? PRGF + - probably ? Rewrite it all with no awl! Is PRP/BMC protecting SC bone from awl damage Is PRP/BMC enhancing integration of OAT
Acknowledgements
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