Guidelines on treatment do not follow a single model, and the different options have not been modified in the last years. Nowadays, it seems that these guidelines on medical and physiotherapeutic treatment have been improved but, from the epidemiologic studies, we know that a frank diminution on the lesion incidence or the relapsing rate has not been produced. So, it is necessary to deeply study on the knowledge and create new strategies for the solution of muscle injuries. The tendinopathies treatment is still very limited for a set of factors such as the healing time, strength and elasticity of the initial reparation diminution as well as the high rate of recurrences. Lately, new expectations are open thanks to research on reparation and biological regeneration through the use of PRP or stem cells that will probably improve the reparation, reduce the leave time and decrease the recurrences rate. Therefore, it is necessary to keep on researching on prevention and treatment of muscle and tendon injuries. This research must be basic and applied to the real needs to help doctors and physiotherapist improving their knowledge and management to face the problems of their patients/sportsmen.
Autologous platelet-rich plasma for tendinopathy and ligament injuries: a systematic review. (Vernooij RWM1and Martinez-Zapata MJ) - Edition 2013
2013 Edition

Investigator: Vernooij RWM1 & Martinez-Zapata MJ

Due to the large amount of stress and force on the tendons during physical exercise, the risk of acute tendon injuries is increased. Similarly, chronic tendinopathies are common in both active and sedentary individuals. One of the adjunctive treatments is the use of platelet-rich plasma (PRP). We performed a systematic review of the literature on the efficacy and safety of PRP injections for patients with tendinopathy and ligament injuries to assess the efficacy of this intervention.

We searched at the databases of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (May 2014). The criteria to include studies were Randomised Controlled Trials (RCTs), comparing PRP with placebo or usual treatment, and evaluating the efficacy and safety or PRP in patient with a clinical diagnosis of tendinopathy or ligament injury at any stage. The eligibility assessment of the studies for inclusion, data extraction, and quality assessment of the included studies was independently conducted by two authors. The extracted variables were related with the methodological quality, characteristics of the study, characteristics of the patients, and outcomes regarding time to complete recovery of lesion, functionality, and pain for both the PRP and control group.

In total 34 studies were included, however, only one RCT reported time to complete recovery, 12 RCTS provide quantitative results on the outcome pain, and 18 RCTs on the outcome functionality. The quality of evidence was in general low or very low. Time to complete recovery was not statistically significant different between the PRP and control group. We found a significant improvement of 0.28 points (95%-CI: 0.04 to 0.53, p=0.02; I2=70%) on the functionality scale (range from 0 to 100). No significant differences between the groups have been found regarding the reduction of pain on the VAS scale. However, analysis of subgroups showed differences in efficacy of PRP by localization of the tendinopathy, the concentration of platelets in PRP, and if co-interventions such as surgery have been conducted.

In conclusion there is very low or low quality evidence that PRP can improve functionality of patients with a tendinopathy. This is mainly due to lack of high-quality large RCTs and the wide variation among the used scales to measure functionality.

New in vivo and in vitro therapeutic approaches for the improvement of Muscle Regeneration and Fibrosis Prevention after Skeletal Muscle Injury (Dr. Mario Marotta ) - Edition 2012
Edition 2012

Researcher: Dr. Mario Marotta

In the present study we have developed a new model of surgically-induced skeletal muscle injury in rats (Figure 1). This animal model allows not only for the study of the complex regulatory pathways involved in skeletal muscle degeneration-regeneration process but also in the development of new stem cell-based or pharmacological therapeutic approaches addressed to promote and ameliorate muscle tissue repair and reduce fibrosis and other adverse effects.

The new established muscle injury animal model mimics the muscle lesions observed in sports human clinics (Figure 2) and could open new avenues for developing new treatments in humans and future clinical trials.

Moreover, we have also analyzed new pharmacological therapeutic approaches in order to determine their efficiency to improve muscle regeneration after injury and the recovery of muscle strength. These treatments have demonstrated their effectiveness to improve muscle strength recovery after surgical injury in our new animal model of skeletal muscle injury in rats (Figure 3). They could be likely used in order to reduce the “return to play” in muscle injuries in sportsmen.

Figure 1. Surgically-induced skeletal muscle injury model in rats. A) Wistar rat animal model. B) Anesthetized animals were fixed in prone position before surgical procedure. C) Injury site incision was precisely determined in medial gastrocnemius muscle. D) Transversal skeletal muscle injury was performed across the muscle.

Figure 2. Histological , Immunofluorescence and MRI analysis during the evolution of surgically-induced skeletal muscle injury in rats. Haematoxylin-Eosin and Immunofluorescence (Col-1 and α-SMA) analysis were carried out at 1, 3, 5, 9, 14 and 21 days after injury (Magnification x10). 7T MRI images (axial view) were obtained in NMR facility of the Autonomous University of Barcelona (Barcelona, Spain).

Figure 3. Comparing the maximum strength percentage of each rat’s injured leg with that of their control leg, we can see that after using any of the three treatments, the maximum strength of the treated rats is bigger than the maximum strength of the control group rats. Groups B and C outstand because they provide a maximum strength of 93 and 94%, respectively, to the injured leg compared to the strength of the non-injured collateral muscle while in non-treated animals, the strength of the injured muscle reaches a 73% compared to the control leg.
Intermittent exposure to hypoxia as a tool for improving recovery from muscle damage induced in laboratory rats.(Dr. Ginés Viscor)- Edition 2010
Edition 2010

Researcher: Dr. Ginés Viscor

Exploratory study to determine the potential efficacy of intermittent exposure to hypoxia in hypobaric chamber in recovery from muscle damage induced in rats. Muscle damage is induced in the hindquartes of the laboratory animals through a session of forced downhill running in accordance with protocols that are widely validated and accepted by the scientific community. Our primary goal is to describe the evolution of plasma markers of muscle damage during recovery in control rats and treated rats. Meanwhile, we are developing a more detailed study of the structural and biochemical changes induced in the muscles of the rat's hind legs.

The animals are divided into three groups: one control group and two experimental groups. the control animals [AMB] go through a passive recovery, living a normal, inactive life. All the experimental animals, however, are administered a programme of intermittent exposure to hypobaric hypoxia. Half the experimental animals [HIP] are given no additional treatment, while the othe half [EHIP], in addition to being exposed to simulated high altitude, are subject to an exercise protocol that is equivalent to a programme to maintain physical fitness /scaled down to the size of the rats).

At each sampling phase some animals (n = 7) are euthanised so the mechanisms involved in the potential improved recovery can be analysed in greater detail by examining samples of muscle and other tissues. For this reason histochemical, immunocytochemical and transcriptomic studies are conducted to assess both structural damage and subsequent changes to that damage.

NB: This study is co-funded by the National Research, Development and Innovation Programme (DEP2010-22205-C02-01).
Clinical trial, Randomized, multicenter, controlled, parallel, double-blind, blinded to treatment evaluator, evaluating the efficacy of Platelet-Rich Plasma in the treatment of muscle tears with hematoma.(Dra. Martínez-Zapata MJ, Dr. Orozo Ll ) - Edition 2009
Edition 2009 Researchers: Dra. Martínez-Zapata MJ, Dr. Orozo Ll

Study PRP-RICE. The Platelet-Rich Plasma (PRP) has hemostatic factors and cell growth that may promote a faster wound healing. This clinical trial asses the efficacy of PRP hematoma muscular injury, in particular the calf injury or the miotendinous distal portion of the rear femoris fascia rectus muscle.

The number of subjects needed for the study is 76 (assuming a 20% loss). Randomly, to a group of patients, the hematoma is evacuated of the muscle injury and autologous PRP is administered and to the other group of patients, only the hematoma is evacuated. All patients are advised to rest, local ice, compressive measures, limb elevation (RICE) and physiotherapy exercises. The primary endpoint of the study is the time to set the full recovery. After the administration of the intervention a weekly, clinical and ultrasound, tracing will be carried out for 8 weeks or until healing (if earlier). Subsequently, a telephone tracing at 6 and 12 months. The evaluation is done as blinded, because it is masked the intervention to the patients and the researchers that trace.

More details of the study in NCT01440725. Study co-funded by the "Fondo de Investigación Sanitaria" (Instituto Carlos III ; PI080724) and the "Fondo Europeo de Desarrollo Regional" (FEDER).

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