A STUDY ON THERAPEUTIC EFFECTS OF PLATELET RICH PLASMA ALONE AND IN CONJUNCTION WITH OZONE THERAPY FOR PARTIALLY RESECTED HAMSTRING TENDON REPAIR IN RABBITS

Main Article Content

Mansoor Ahmad Subhani
Naveed Hussain
Ayesha Safdar
Zia Ullah
Haroon Akbar
Ali Qaiser
Sohaib Safdar
Areesha Arkan

Keywords

Hamstring tendon, medical ozone, ozonated saline, platelet rich plasma, tendinopathies, Achilles rupture

Abstract

In recent years, an interest in rehabilitation therapies has sufficiently increased, especially in the field of sports medicine. Hamstring tendon partial tears are very common in this regard and are mainly associated with trauma, chronic tendinopathies and degenerative conditions etc., which are very difficult to cure. Among their rehabilitation therapies along with standard surgical procedures include platelet rich plasma, medical ozone etc. PRP with higher platelet concentrations have abundant cytokines and growth factors that stimulate tissue healing. Medical ozone has special antioxidant, immunoregulatory and analgesic properties which may be highly useful to treat musculoskeletal injuries. In our studies, we selected a total of 18 rabbits that were allocated to 03 groups (n=06). Partial tendon resection was done, and surgical repair was managed with Krackow’s suture pattern in all rabbits. Group A (sutures) served as control, while group B and C were administered with PRP and O3-PRP, respectively @ 0.5 mL, four times a week. The study was carried out for 5 weeks and therapeutic regimens were monitored on day 0, 1, 7,14, 21, 28 and 35 in terms of physiological vitals, hematology parameter, radiology, ultrasonography, histology and scanning electron microscopy. We noticed excellent tendon healing in group C (O3-PRP) with abundant cytokines, growth factors, O3 based oxidative stress and pathogen control. Group B showed good cure due to numerous thrombocyte mediators but it lagged behind group C, whereas group A revealed poor healing among all. Though the use of these regimens in vivo needs further trials, but in the complex scenario of hamstring injuries management we may suggest that ‘medical ozone-PRP’ had beneficial effects for the tendon partial rupture than PRP alone or the sutures.

Abstract 59 | pdf Downloads 37

References

1. Doherty GP, Koike Y, Uhthoff HK, Lecompte M, Trudel G. Comparative anatomy of rabbit and human Achilles tendons with magnetic resonance and ultrasound imaging. Comparative medicine. 2006;56(1):68-74.
2. Marican MM, Fook-Chong SMC, Rikhraj IS. Incidence of postoperative wound infections after open tendo Achilles repairs. Singapore medical journal. 2015;56(10):549.
3. Shamrock AG, Dreyer MA, Varacallo M. Achilles tendon rupture. StatPearls [Internet]: StatPearls publishing; 2023.
4. Lohrer H. Minimum 3.5-year outcomes of operative treatment for Achilles tendon partial tears in the midportion and retrocalcaneal area. Journal of Orthopaedic Surgery and Research. 2020;15:1-15.
5. Takamura M, Yasuda T, Nakano A, Shima H, Neo M. The effect of platelet-rich plasma on Achilles tendon healing in a rabbit model. Acta Orthopaedica et Traumatologica Turcica. 2017;51(1):65-72.
6. Kim U, Choi YS, Jang GC, Choi YR. Early rehabilitation after open repair for patients with a rupture of the Achilles tendon. Injury. 2017;48(7):1710-3.
7. Kizilkaya V, Uruc V, Levent A, Kanat O, Yildizgoren MT, Dogramaci Y, et al. Effectiveness of Ozone Therapy on Tendon Healing: An Experimental Study in Generated Achilles Tendon Injury Model in Rats. Journal of Hard Tissue Biology. 2018;27(4):309-14.
8. Monto RR. Platelet rich plasma treatment for chronic Achilles tendinosis. Foot & Ankle International. 2012;33(5):379-85.
9. Peteoacă A, Istrate A, Goanță AM, IONAȘCU I, Tănase A. The use of ozone therapy in veterinary medicine: a systematic review. AgroLife Scientific Journal. 2020;9(2).
10. Latini E, Curci ER, Massimiani A, Nusca SM, Santoboni F, Trischitta D, et al. Ultrasonography for oxygen-ozone therapy in musculoskeletal diseases. Medical Gas Research. 2019;9(1):18-23.
11. Dernek B, Kesiktas FN. Efficacy of combined ozone and platelet-rich-plasma treatment versus platelet-rich-plasma treatment alone in early stage knee osteoarthritis. Journal of back and musculoskeletal rehabilitation. 2019;32(2):305-11.
12. Barter LS, Hawkins MG, Pypendop BH. Effects of fentanyl on isoflurane minimum alveolar concentration in New Zealand White rabbits (Oryctolagus cuniculus). American journal of veterinary research. 2015;76(2):111-5.
13. Bellido C, Abellán C, Molina A, Blanco A, Moyano R. Histopathological study of the Achilles tendon after exposure to Bisphenol-A and its subsequent treatment with platelet growth factors. 2018.
14. Fossum TW. Small Animal Surgery E-Book: Elsevier Health Sciences; 2018.
15. Slatter DH. Textbook of small animal surgery: Elsevier health sciences; 2003.
16. Heitman DE, Ng K, Crivello KM, Gallina J. Biomechanical comparison of the Achillon® tendon repair system and the Krackow locking loop technique. Foot & ankle international. 2011;32(9):879-87.
17. Handoyo HR, Hidayat M, Sardjono TW, Soeharto S, Dzulkarnain SA. Perfecting Achilles Tendinopathy Inducement: Preliminary Study in Animal Model-BONAR Score as Quantitative Indicator. Muscles, Ligaments & Tendons Journal (MLTJ). 2023;13(1).
18. Perez AG, Lana JFS, Rodrigues AA, Luzo ACM, Belangero WD, Santana MHA. Relevant aspects of centrifugation step in the preparation of platelet-rich plasma. International Scholarly Research Notices. 2014;2014.
19. Gurger M, Once G, Yilmaz E, Demir S, Calik I, Say Y, et al. The effect of the platelet-rich plasma and ozone therapy on tendon-to-bone healing in the rabbit rotator cuff repair model. Journal of Orthopaedic Surgery and Research. 2021;16:1-9.
20. Bocci V, Zanardi I, Borrelli E, Travagli V. Reliable and effective oxygen-ozone therapy at a crossroads with ozonated saline infusion and ozone rectal insufflation. Journal of Pharmacy and Pharmacology. 2012;64(4):482-9.
21. Zabrzyńska M, Grzanka D, Zielińska W, Jaworski Ł, Pękala P, Gagat M. The Bonar Score in the Histopathological Assessment of Tendinopathy and Its Clinical Relevance—A Systematic Review. Medicina. 2021;57(4):367.
22. Athanassious C, Samad A, Avery A, Cohen J, Chalnick D. Evaluation of fever in the immediate postoperative period in patients who underwent total joint arthroplasty. The Journal of Arthroplasty. 2011;26(8):1404-8.
23. Rangel-Frausto MS, Pittet D, Costigan M, Hwang T, Davis CS, Wenzel RP. The natural history of the systemic inflammatory response syndrome (SIRS): a prospective study. Jama. 1995;273(2):117-23.
24. Tran QT, Nguyen MH. Clinical and laboratory characteristics of patients after surgery of tibial fracture at Soc Trang Provincial general Hospital. Tạp chí Khoa học Điều dưỡng. 2022;5(1):6-13.
25. Kraft CN, Krüger T, Westhoff J, Lüring C, Weber O, Wirtz DC, et al. CRP and leukocyte-count after lumbar spine surgery: fusion vs. nucleotomy. Acta orthopaedica. 2011;82(4):489-93.
26. Wang R, Gao R, Xie X, Chen H, Zhao Q, Zhang X, et al. Perioperative platelet count in peripheral blood is associated with the early stage of PND after major orthopedic surgery: a prospective observational study. BMC geriatrics. 2022;22(1):1-13.
27. Galeano M, Altavilla D, Bitto A, Minutoli L, Calò M, Cascio PL, et al. Recombinant human erythropoietin improves angiogenesis and wound healing in experimental burn wounds. Critical care medicine. 2006;34(4):1139-46.
28. Jagow DM, Yacoubian SV, Yacoubian SV. Complete blood count before and after total hip or knee arthroplasty. Journal of Orthopaedic Surgery. 2015;23(2):209-12.
29. Fitzpatrick E, Holland OJ, Vanderlelie JJ. Ozone therapy for the treatment of chronic wounds: A systematic review. International wound journal. 2018;15(4):633-44.
30. Hussain N, Khan MA, Mahmood AK, Tipu MY, Chaudhry M, Rashid HB, et al. A Comprehensive Study on Bioengineering Strategies of Osseous Reconstruction by Using Autogenous Bone Graft with Osteogenic Biologics for Radial Diaphyseal Defect Repair. 2022.
31. Restuccia G, Varchetta G, Lippi A, Dolfi L, Bizzocchi F, Giovannetti S, et al. Platelet rich plasma (PRP) in the surgical treatment of Haglund’s syndrome: the use of PRP membranes as an intra-operative local adjuvant. Med Glas (Zenica). 2024;21(1):196-202.
32. Amroodi MN, Kordkandi SA, Moghtadaei M, Farahini H, Amiri S, Hajializade M. A Study of Characteristic Features and Diagnostic Roles of X-ray and MRI in Calcifying Tendinitis of the Shoulder. Medical Journal of the Islamic Republic of Iran. 2022;36.
33. Gautam V, Verma S, Batra S, Bhatnagar N, Arora S. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. Journal of Orthopaedic Surgery. 2015;23(1):1-5.
34. Hiramatsu K, Tsujii A, Nakamura N, Mitsuoka T. Ultrasonographic evaluation of the early healing process after Achilles tendon repair. Orthopaedic Journal of Sports Medicine. 2018;6(8):2325967118789883.
35. Mostafa J, Ali Y, Zohre R, Samaneh R. Electromagnetic fields and ultrasound waves in wound treatment: A comparative review of therapeutic outcomes. Biosci Biotechnol Res Asia. 2015;12(1):185-95.
36. Batista de Souza J, Rodrigues D, Faquim Rodrigues PC, Gonzaga Lopes L, Costa Firmiano T, Estrela CR, et al. Characterization of dentin morphology after application of ozone and sodium ascorbate by scanning electron microscopy and atomic force microscopy. RSBO: Revista Sul-Brasileira de Odontologia. 2020;17(2).
37. Maciel FB, DeRossi R, Módolo TJ, Pagliosa RC, Leal CR, Delben AA. Scanning electron microscopy and microbiological evaluation of equine burn wound repair after platelet-rich plasma gel treatment. Burns. 2012;38(7):1058-65.

Most read articles by the same author(s)