PRP enhancement of OLT treatment. Lisa A. Fortier, DVM, PhD, DACVS - - PowerPoint PPT Presentation

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Feb 10, 2023 437 likes •585 views

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

SLIDE 1

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

Cornell University College of Veterinary Medicine

SLIDE 2

Disclosures

Consultant: Arthrex, Veterinary Recommended

Nutraceuticals, TissueGen

Royalties: Arthrex
Scientific Board: Kensey Nash

SLIDE 3

What does the literature say?

LOE Pathology Biologic Follow- up Message Citation V OLT PRP BMC NA In vivo and in vitro support Smyth WJO 2012 II OLT (32) nonop 3PRP:3HA PRGF leucolo 6 mo PRP & HA helped PRP>HA Mei-Dan AJSM 2012 IV various PRP NA inconclusive Viannini F&A Surg 2014 II OLT (40) mFx 1PRP:1HA:1saline leucohi 11-25 mo PRP &HA helped PRP>HA Gormelli F&A Int 2015 II OLT (35) mFx ±PRP 4ml leucohi buffered 12-24 mo PRP improved fxn Guney KSSTA 2015 II OLT (44) mFx ±PRP: AOTS 4ml leucohi buffered 12-84 mo All improved AOTS>mFx 20% mFx reop Guney KSSTA 2016 II OLT, OCD PRP or HA NA It’s working Jazzo, J Sport Rehab 2017

SLIDE 4

Put down your awl!

AJSM 2009 Gianakos Arthroscopy 2016 Small is better, but damage inevitable

SLIDE 5

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 McIlwraith, Arthroscopy 2011 Courtesy, John Kennedy

SLIDE 6

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)

SLIDE 7

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

SLIDE 8

72 patients OAT with BMAC with mean 28 months FU

– Improved T2 mapping

Kennedy et al. Cartilage 2011

BMC for OAT?

Buckley et al, J Biomech 2008, 2010

} 50uM

Courtesy, Kennedy

SLIDE 9

IL-1ra / Orthokine / IRAP

SLIDE 10

Gilbertie JM, Schnabel LV, Schaer TP https://schnabellab.cvm.ncsu.edu

Bioactive factors from platelets combat biofilm infections and antimicrobial recalcitrance

L -P R P P R P P P P N O N E A B X 2 4 6 8 1 0

F o rm u la tio n s

lo g C F U /m L a c b d d

S. aureus ATCC 25923

+ WBC

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P R P A -P R P P R P -L P P P A B X N O N E 2 4 6 8 1 0

In c re a s e d P o te n c y

lo g C F U /m L a b c d e e

Activation or lysis of platelets increases efficacy

S. aureus ATCC 25923
WBC

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P R P P R P -L P P P N O N E 2 4 6 8 1 0

M u ltip le Is o la te E ffic a c y

lo g C F U /m L

S . a u re us E . co li P . a eru gino sa S . zo o e p id e m icus

a b c d a a a b b b c c c d d d

PRP-L is effective against multiple arthrotropic isolates

SLIDE 13

Which one is best for OLT?

Biologic Growth factors Contain MSC Recruit MSC Antimicrobial Bone?

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

SLIDE 14