6. Intérêt Visco-PRP
Le PRP a un effet anti-inflammatoire naturel (secrétion de cytokines
anti-inflammatoires)
PRP : « le corticoide sans les inconvénients »
Il a de fait un effet antalgique
On connaît aussi son effet antibiotique
L’article de Sundman et l’expérience pratique de 3 ans de recul
démontrent que l’association thérapeutique AH exogène + PRP
autologue est très intéressante par effet de sommation (douleur,
fonction)
Le PRP favorise par ailleurs la synthèse d’AH endogène
7. HOW TO PREPARE PRP-HA CELLULAR MATRIXâ ?
THE STEPS : Very fast Procedure !
1/Blood puncture
2/Centrifugation : 5 mn / 3500
3/Turning round PRP & HA to obtain & homogenize the cocktail (≥4 cc)
After withdrawal
of full blood
After
centrifugation
After
homogenization
HA
PRP
CELLULAR MATRIX (PRP-HA, class III material device)
Sampling before injection
4 cc (2 ml PRP + 2 ml non cross linked HA)
12. L’élément majeur est la pauvreté en Neutrophiles
des produits Regenlab (efficacité/disparité littérature)
13. Mode Opératoire de l’Injection Articulaire :
CT ou RX ou US (analgésie, MEOPA)
CT ou RX : bulle d’air, voie postéro-médiale ou latérale selon siège
méniscarthrose genou, voie sous-rotulienne, voie antérieure
hanche/cheville/épaule, coude….poignet….rachis….
Il faut être dans l’articulation et prés de la lésion !
14. Les cibles de la Visco-PRP
1/Lésions méniscales stables stade II et III sur genou stable
Ménisques suturés à risque, Kystes méniscaux
(Ph ADAM, M Noat, Biobridge Venise, Septembre 2013)
Kyste méniscal
Classification IRM
15. *Peripheral Vascularity seem to play an important role in meniscal healing
*But deep meniscus is also soaking into the joint fluid !
*Therefore growth factors can impact meniscal healing by stimulation of
vascular proliferation and by impregnation
R R R W WW
16. Results and Profits of « PRP therapy »
for meniscal lesions
* Positives : 92% for group 1 (grade III, meniscal cyst : 116/126)
Clinical aspect : Constant antalgic effect of PRP (anti inflammatory
effect of growth factors), better joint ability
Imaging aspect : reduced inflammation of the joint , decrease or
stabilization of meniscal lesion (cyst, cleft)
Failures (10/126) are owed to a bad evaluation of lesional stability
(a good diagnosis by imaging is essential+++)
* Positives : 100% for group 2. We can improve the rate success for
meniscal suture
18. Meniscal Lesions : Clinical Cases
Anterior horn cyst of LM january 2013
Anterior horn cyst of LM may 2013
19. LM before and after suture completed by PRP injection
(bucket handle) : no scar is visible !
before
after
20. 1/Big functional disability, pain 4/10, 64 years old 2/walk normally, pain 0/10
After PRP :
Inflammation Decrease
(paratibial fluid collection)
Improved medial meniscal
structure
Before PRP After PRP
21. Cleft and Cyst of MM (ultrasonography)
One month after PRP
22. Running, postural internal pain (6/10) Grade III lesion of MM (before PRP)
At one month : decreasing pain (0/10) decreasing size and intensity of meniscal cleft
23.
24. Les cibles de la Visco-PRP
2/Arthrose du genou : stades non chirurgicaux, nombreux échecs de
la visco simple
Si nécessaire assécher l’articulation avant (ponction + corticoides)
Dr JLRenevier Hôpital de Meulan
Dr Jean-François MARC 42300 Roanne
Dr Philippe ADAM Médipôle Garonne 31100 Toulouse
Dr Jacques LE COZ 75014 Paris
Dr Ivan PROTHOY Polyclinique des Alpes du Sud 0500 Gap
Pr Nicolas SANS Hôpital Purpan Place du Dr Baylac
TSA 40031 31059 Toulouse
Biobridge Venise Septembre 2014
26. RESULTS
*87.3% improved after the study patients
*There is a significant difference in the average WOMAC
A1 before the start of treatment and pain 36 weeks after
starting treatment
*This difference was also significant between the first and
the second injection and between the second and third
injection.
*There is no significant difference in pain scores as the
radiological grade (II-III)
*No significant side effects reported.
29. Woman 40 yo, overweight, internal pain 4/10 MRI at one month, pain 0/10
Obvious decrease of the
oedema of the
internal condyle
Slight modification of the
signal of medial
meniscus
Le marqueur de la
douleur c’est l’oedème
en IRM
30. Les cibles de la Visco-PRP
3/Arthrose de hanche : conflits, complémentaire ou alternative à la
Dysplasia and/or Impingement
chirurgie (labrum)
If impingement : Cam effect/Pincer effect/ or Mixt
Cartilaginous +/- fibro-cartilaginous labral lesions
Sport Practice
Surgery before CM injection for impigement
Failure of NSAIDs and classic visco-supplementation
31. Oxford Score : Synthesis
Mean score before injection is 30 (moderate)
Mean score after two injections is 37,6 (mild) : 25% increase
6/13 have satisfactory joint function (46%) after 2 injections
No side effects after CM injection
Good progress and improvement specially for patients with
impigement (37% versus 17% for other group)
Separated case 14 (cam) : before 16 (severe), and after one CM
injection 37 (mild, over 50%)
33. Case 1 : soccer player, M 43 yo, no impigement,
Tönnis 2, oxford 31/34/41 (32% improvement)
34. French XV International Rugby Player : Traumatic lesion of labrum
(acetabular tear/oedema), AH only no result, PRP at one month rapidly
permit decreasing of pain, normal function,
with no recurrence over one year
oedema
Labral tear
No oedema
35. Labral and Meniscal Treatment by Visco-PRP
is the Same fight !
1/ Preventive Labral Treatment is so efficient as meniscal
2/ Hip Labral-Arthritis = Knee Meniscal-Arthritis
3/Save labrum = Protect hip and slow down arthritis
36. Detection of pre-arthritis and Preventive
Treatment are the Goal in the Young !
1/ Corrective surgery to avoid prosthetic device
2/ 40% arthritis (hip) under 50 yo considered as
« idiopathic » : Not detected Impigement ?
3/ Visco-PRP (HA + PRP) complete corrective surgery
37. Which is the new deal for Degenerative Arthritis ?
Early Screening
(bio-markers+++)
+ Early Treatment
= Prevention and Efficiency
Visco-PRP Surgery
Editor's Notes
The infiltration into the meniscus wall of activated PRGF Endoret, stained with methylene blue, shows the
diffusion of PRGF through a broad meniscal area.