Operative Techniques in Orthopaedics RSS feed: Current Issue. Operative Techniques in Orthopaedics is an innovative, richly illustrated resource that keeps practitioners informed of significant advances in all areas of surgical management. Each issue of this atlas-style journal explores a single topic, often offering alternate approaches to the same procedure. Its current, definitive information keeps readers in the forefront of their specialty. http://www.optechorthopaedics.com/?rss=yesElsevier Inc.en © 2012 Published by Elsevier Inc. All rights reserved. Operative Techniques in Orthopaedics1048-6666221March 2012 © 2012 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.optechorthopaedics.com/article/PIIS1048666612000092/abstract?rss=yesEditorial Board10.1053/S1048-6666(12)00009-2Operative Techniques in Orthopaedics 22, 1 (2012)2012-03-01Operative Techniques in Orthopaedics2012-03-01221S1048-6666(12)X0002-8iihttp://www.optechorthopaedics.com/article/PIIS1048666612000109/abstract?rss=yesTable of Contents10.1053/S1048-6666(12)00010-9Operative Techniques in Orthopaedics 22, 1 (2012)2012-03-01Operative Techniques in Orthopaedics2012-03-01221S1048-6666(12)X0002-8iiiihttp://www.optechorthopaedics.com/article/PIIS1048666612000110/abstract?rss=yesContributors10.1053/S1048-6666(12)00011-0Operative Techniques in Orthopaedics 22, 1 (2012)2012-03-01Operative Techniques in Orthopaedics2012-03-01221S1048-6666(12)X0002-8iiiiiihttp://www.optechorthopaedics.com/article/PIIS1048666612000055/abstract?rss=yesPlatelet Rich Plasma (PRP) is increasingly used for management of musculoskeletal disorders, especially in elite athletes who need to early return to competition. From a purely scientific view point, the wide application of PRP in clinical settings is not strongly supported by level I studies. PRP is a fraction of autologous plasma containing an above baseline platelet concentration and growth factors which take part in post-traumatic healing process. Platelets contain, synthesize and release biologically active proteins such as platelet-derived growth factor (PDGF), transforming growth factor (TGF-β), platelet-derived epidermal growth factor (PDEGF), vascular endothelial growth factor (VEGF), insulin-like growth factor 1 (IGF-1), fibroblastic growth factor (FGF), and epidermal growth factor (EGF). By inducing cell proliferation and synthesis of angiogenic factors, PRP is supposed to be beneficial for soft and hard musculoskeletal tissue injuries, but much has to be elucidated around its use in clinical practice and its role in healing and repairing processes.IntroductionNicola Maffulli10.1053/j.oto.2012.01.003Operative Techniques in Orthopaedics 22, 1 (2012)2012-03-01Operative Techniques in Orthopaedics2012-03-01221S1048-6666(12)X0002-812http://www.optechorthopaedics.com/article/PIIS1048666611001248/abstract?rss=yes Knowledge of the basic biological mechanisms involved in tissue response to injury should inform management of healing. Approaches to influence healing may need to integrate multiple cell types and large signaling networks that are necessary for the dynamic communication between cells. Platelet-rich plasma (PRP) therapies deliver a myriad of growth factors and cytokines to the injured tissues. Evolution of our understanding of platelet biology and reinterpretation of some of their more traditional roles in hemostasis and tissue repair have revealed much about the complexity of PRP therapies and provide new insights on PRP therapies' successes and failures. However, many potential molecular mechanisms acting simultaneously in tissue repair present a challenge to the identification of critical mechanisms behind PRP therapies. A vast array of barriers, ranging from deficits in basic research to clinical differences in formulations and administration procedures, undermine current efforts to set effective PRP protocols to manage healing. Identifying which molecular mechanisms are more or less important during the course of healing and clarifying the molecular basis for differences in the healing response across patients will continue to be the priority to tailor PRP therapies for particular sports injuries. Basic Science: Molecular and Biological Aspects of Platelet-Rich Plasma TherapiesIsabel Andia, Mikel Sánchez, Nicola Maffulli10.1053/j.oto.2011.09.005Operative Techniques in Orthopaedics 22, 1 (2012)2012-03-01Operative Techniques in Orthopaedics2012-03-01221S1048-6666(12)X0002-839http://www.optechorthopaedics.com/article/PIIS1048666612000043/abstract?rss=yes Platelets are anucleate blood cells characterized as primary effectors of hemostasis. The rationale for the therapeutic use of platelets as a surgical adjuvant is to make platelet-derived factors locally available for tissue healing. Several platelet-derived growth factors have been recently characterized, able to favor both wound healing and angiogenesis. Biological therapies using platelet-rich plasma (PRP) preparations are currently being used, making it essential to expand our knowledge on the sequential events that characterize PRP action. Studies on the efficacy of PRP in human subjects are still scarce, probably because of the relatively recent clinical applications of PRP. In some case control studies and in several noncontrolled clinical trials, PRP has been found effective. However, the results of most studies are hampered by relevant confounding variables such as the variations of PRP characteristics even in patients with similar platelet counts. PRP essentially acts as a growth factor reservoir, inducing mitogenesis, chemotaxis, and angiogenesis at the site of application. However, notwithstanding several different characteristics between them, all platelet-enriched products are called PRP, which makes the distinctions difficult. Hence, although PRPs represent a promising tool of clinical application, many questions are still open, such as the appropriate indications for its clinical use as well as the effective concentrations and quantities for each product to be used in each therapeutic situation. Platelet-Rich Plasma Preparations for Biological Therapy: Applications and LimitsGiuliana Gobbi, Marco Vitale10.1053/j.oto.2012.01.002Operative Techniques in Orthopaedics 22, 1 (2012)2012-03-01Operative Techniques in Orthopaedics2012-03-01221S1048-6666(12)X0002-81015http://www.optechorthopaedics.com/article/PIIS1048666611001455/abstract?rss=yes Platelet-rich plasma (PRP) products represent advanced regenerative therapies for acute and chronic muscle and for tendon injuries because they can exploit the regenerative capabilities of the musculoskeletal system. PRP injections are used in clinical practice, but there is a need to evaluate the claims made about PRP therapies. Herein, we review current published clinical studies and focus on PRP formulations and application procedures. This article also describes the authors' clinical experience with PRP therapy in muscle and tendon conditions during the past decade. Treatment effects and the primary conclusions of clinical studies may be affected by procedures of PRP administration, and estimates of PRP treatment effect may deviate from its true value. To better define the conditions of clinical trials, we need to know more about the differences not only between PRP formulations but also among technical procedures in surgery and injection protocols, including applied volumes, target areas to treat, treatment schedules, and patient selection criteria. Platelet-Rich Plasma in Muscle and Tendon HealingMikel Sánchez, Javier Albillos, Francisco Angulo, Juanma Santisteban, Isabel Andia10.1053/j.oto.2011.11.003Operative Techniques in Orthopaedics 22, 1 (2012)2012-03-01Operative Techniques in Orthopaedics2012-03-01221S1048-6666(12)X0002-81624http://www.optechorthopaedics.com/article/PIIS1048666612000067/abstract?rss=yes Platelet-rich plasma is a set of autologous platelet products used to accelerate recovery from injury. The basic rationale is to mimic the natural ways of healing, bringing to the injury site a set of molecules that will accelerate the functional recovery of the tissue, trying to regenerate the tissue itself, and not to merely repair with scar tissue. Among the jungle of products in this field, PRGF-Endoret (BTI-Biotechnology Institute, Vitoria, Spain) is a pioneering autologous regenerative technology with multiple therapeutic potentials, present in at least 4 different formulations, depending on the coagulation and activation degree of the samples. PRGF-Endoret technology is safe and has multiple applications and potentials. Platelet-Rich Plasma: Preparation and FormulationEduardo Anitua, Roberto Prado, Mikel Sánchez, Gorka Orive10.1053/j.oto.2012.01.004Operative Techniques in Orthopaedics 22, 1 (2012)2012-03-01Operative Techniques in Orthopaedics2012-03-01221S1048-6666(12)X0002-82532http://www.optechorthopaedics.com/article/PIIS1048666611001212/abstract?rss=yes Multiple studies have demonstrated a role for platelet-rich plasma (PRP) in accelerating and facilitating improved response to injury. The cellular response to injury progresses through 4 general stages: hemostasis, inflammation, proliferation, and finally remodeling. Each phase is characterized by enhanced cellular or molecular activity, all of which involve platelets. Blood plasma and platelets are responsible for hemostasis, whereas leukocytes and activated platelets mediate inflammation, and growth factors derived from platelet α-granules influence tissue regeneration. Specifically, the leukocyte content of PRP is thought to influence the inflammatory phase, whereas angiogenic and mitogenic growth factor concentrations are believed to aid tissue regeneration. Both the precise composition of PRP and its formulation affect the cellular environment in which it is placed and determine its overall effect on tissue repair. Contents and Formulations of Platelet-Rich PlasmaAmy S. Wasterlain, Hillary J. Braun, Jason L. Dragoo10.1053/j.oto.2011.11.001Operative Techniques in Orthopaedics 22, 1 (2012)2012-03-01Operative Techniques in Orthopaedics2012-03-01221S1048-6666(12)X0002-83342http://www.optechorthopaedics.com/article/PIIS104866661100125X/abstract?rss=yesAcute and chronic musculoskeletal injuries in sports are common and problematic for both athletes and clinicians. A significant proportion of these injuries remain difficult to treat, and many athletes suffer from decreased performance and long-standing pain and discomfort.The Use of Platelet-Rich Plasma in Sports Medicine—the International Olympic Committee OpinionLars Engebretsen, Patrick Schamasch10.1053/j.oto.2011.10.006Operative Techniques in Orthopaedics 22, 1 (2012)2012-03-01Operative Techniques in Orthopaedics2012-03-01221S1048-6666(12)X0002-84348