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Dean G. Sotereanos , MD Clinical Professor of Orthopaedic Surgery

Lateral epicondylitis : Stem Cells and Growth Factors 2018: Time to Get on Board!. Dean G. Sotereanos , MD Clinical Professor of Orthopaedic Surgery University of Pittsburgh School of Medicine Orthopaedic Specialists - UPMC Pittsburgh , PA. Prevalence

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Dean G. Sotereanos , MD Clinical Professor of Orthopaedic Surgery

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  1. Lateral epicondylitis: Stem Cells and Growth Factors 2018: Time to Get on Board! Dean G. Sotereanos, MD Clinical Professor of Orthopaedic Surgery University of Pittsburgh School of Medicine OrthopaedicSpecialists - UPMC Pittsburgh, PA

  2. Prevalence 1-3% of population Lateral Epicondylitis • local elbow tenderness & pain with resisted wrist extension at the origin of the ECRB • related to overuse, leading to microtears in the origin of the ECRB on the lateral epicondyle Connell D, Datir A, Alyas F, Curtis M. Br J Sports Med 2009 Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, Ramsey ML, Karli DC, Rettig AC. Am J Sports Med. 2014

  3. Histologically Lateral Epicondylitis angiofibroblastic & myxoid degeneration without acute inflammation which is thought to be secondary to failure of the natural tendon-repair mechanism GautamVK, Verma S, Batra S, Bhatnagar N, AroraS. J Orthop Surg 2015 Nirschl RP, Ashman ES. Clin Sport Med 2001

  4. Lateral Epicondylitis Non-operative treatment

  5. Platelet-rich plasma • Autologous blood product which contains concentrated platelets • Releases GFs (IGF, TGF-β, VEGF) mediate cell migration & angiogenesis

  6. Lateral epicondylitis Platelet-rich plasma - Literature No definitive evidence of better efficacy than other treatments lack of standardization in the preparation and composition of PRP is a major impairment in the evaluation of current data

  7. Lateral epicondylitis Platelet-rich plasma

  8. Platelet-rich plasma

  9. Platelet-rich plasma

  10. Lateral epicondylitis Platelet-rich plasma

  11. Platelet-rich plasma

  12. Platelet-rich plasma

  13. Platelet-rich plasma

  14. Risk of bias also plays a significant role in influence of the available evidence

  15. are unspecialized cells with the ability to self- renew and to differentiate into various tissue types Stem cells

  16. can be derived from adult bone marrow stromal or mesenchymalstem cells (MSCs) Stem cells Therapies Autologous MSCs can be harvested from: - bone marrow - adipose tissue - peripheral blood - subacromial bursa Ahmad Z, Wardale J, Brooks R, Henson F, Noorani A, Rushton N. Arthroscopy 2012 Perdisa F, Gostyn ́ ska N, Roffi A, Filardo G, Marcacci M, Kon E. Stem Cells Int. 2015

  17. Animal model studies -Tendinopathies treatment with MSCs: Stem cells Therapies • more normal histological characteristics • improved biomechanical properties • better functional outcomes after healing Watts AE, Yeager AE, Kopyov OV, Nixon AJ. Stem Cell Res Ther. 2011 Chong AK, Ang AD, Goh JC, Hui JH, Lim AY, Lee EH, Lim BH. JBJS Am 2007

  18. Stem cells Therapies currently limited clinical evidence for lateral epicondylitis however the initial results appear promising only uncontrolled pilot studies

  19. Stem cells – Lateral Epicondylitis

  20. Stem cells – Lateral Epicondylitis

  21. Stem cells – Lateral Epicondylitis

  22. PRP & stem cell therapies • Much more lucrative than CS or saline mean cost $ 5,156 (range $ 1,500 – 12,000) • Not always covered by insurance

  23. “an explosion of mom-and-pop shops with little or no regulation” “whether we like it or not, orthopaedics is in the middle of it. There is a concern in the orthopaedic community that we need to stay on top of this as an Academy and as a profession” William J. Maloney, MD 2017 AAOS president

  24. Very few randomized prospective, placebo-controlled trials for PRP or stem cells to assist in recommending the best evidence-based management for lateral epicondylitis Conclusion

  25. Thank You

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