Medical Studies

At ActiJoint, we strive to stay up to date on the latest advancements in joint pain treatment. With such fast growing technology in orthopedics, there are varying opinions on the best treatments for joint pain and other such ailments, so it can be difficult to trust everything you hear. Our policy is one of complete transperancy regarding your treatment. We want you to not just take our word for what is best, but we want you to be able to have the upmost confidence that we are offering the best treatments available in science today. We have included studies we draw our findings from here below for any questions you might have concerning the science behind our medicine. If you have any questions about anything in the studies, we would love for you to call and one of our providers will help answer them for you.

NOTE: We are continually adding new studies to this page as we keep up with scientifc advacements with orthopedic medincine. As a result, this page is not a complete list of the studies we use to make our decisions and recommendations. If you have any questions on any of the medicine we use, please feel free to call one of our providers, as we would love to answer your questions. Your treatment is yours to determine, and we want you to be fully informed.

PRP (platelet-rich plasma)

– PRP is more effective than HA as measured by pain and function. It also caused cartilage growth, better blood flow to the joint capsule, and less swelling of the knee.
https://www.ncbi.nlm.nih.gov/pubmed/29878617

– PRP is helpful at all stages of OA. “Although research has shown a tendency toward better efficacy at earlier stages of osteoarthritis (OA), evidence exists to indicate positive effects at all stages of OA.”
https://www.ncbi.nlm.nih.gov/pubmed/30350299

– Benefits of PRP combined with HA injections.
1) improves pain and function more than either alone
2) enhances the recruitment and migration of fibroblasts (cartilage growing machines)
3) promotes cartilage regeneration
4) inhibits inflammation
5) controls the delivery of signaling molecules (better timing of growth factor release)
https://www.arthroscopyjournal.org/article/S0749-8063(18)30118-X/pdf

– PRP aids with tendon injuries. PRP is involved in all different phases of the repair process (recruitment and mobilization of MSCs, stimulate tendon cells to secrete collagen, VEGF, and HGF (all of them reparative), proliferation and division of MSCs, maturation of newly formed collagen, clean up of excess cells).
https://www.ncbi.nlm.nih.gov/pubmed/22902984

– PRP accelerates tendon repair.
Peak of fastest growth occurs at a platelet concentration of 500,000/uL–too high of too low is inhibitory. (this is a breakthrough because most providers will try to concentrate PRP for tendons as high as possible).
https://www.hindawi.com/journals/bmri/2014/630870/

– PRP and its application in trauma and orthopaedic surgery. Patients who did not respond to conservative therapy (PT and cortisone) for epicondylitis were treated with PRP. A single injection helped all, sustained over 1 year, no complications.
https://www.ncbi.nlm.nih.gov/pubmed/19651823

Not all PRP is created equal:

Monocytes are good.
– Peripheral blood mononuclear cells enhance the anabolic effects of platelet-rich plasma on anterior cruciate ligament fibroblasts.
Neutrophils are catabolic (stimulate tissue breakdown).
Monocytes are anabolic (stimulate tissue growth).
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3469725/

– Monocytes are the driving influence in the progression through the phases of healing.
Primary function is regenerative–remodeling, vascularization, and prevention of scar tissue.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898192/

– Contributions for classification of platelet rich plasma. Monocytes are as important as platelets, key elements in the repair process.
https://www.ncbi.nlm.nih.gov/pubmed/28758836

RBCs are bad:
– There should be an upper limit to the number of RBCs allowed in PRP because of chondrotoxicity.
https://www.arthroscopyjournal.org/article/S0749-8063(18)30118-X/pdf

-RBCs decrease cell function and cause cell death.
https://www.ncbi.nlm.nih.gov/pubmed/20338501

-If RBCs are too high, it abolishes the capacity for stem cells to migrate.
https://www.gavinpublishers.com/articles/Mini-Review/Journal-of-Orthopedic-Research-and-Therapy-ISSN-2575-8241/Bone-Marrow-Concentrate-for-Treatment-of-Knee-Osteoarthritis-A-Mini-Review

Neutrophils are bad:
– Neutrophils release toxic molecules which damage muscle cells.
https://www.ncbi.nlm.nih.gov/pubmed/18937524

– Neutrophils are primarily responsible for WBC-induced inflammation, catabolism, and scar tissue formation.
https://www.researchgate.net/publication/241279597_Platelet_rich_plasma_injections_for_tendinopathy_and_osteoarthritis
Catabolic signals may hinder healing because of inflammatory cytokines.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5964274/

HA (Hyaluronic Acid Injections)
– The effect of repeated intra-articular injections of hyaluronic acid in knee osteoarthritis
https://www.ncbi.nlm.nih.gov/pubmed/21852252?report=abstract

– Do Hyaluronic Acid Injections Delay Total Knee Replacement Surgery?
https://acrabstracts.org/abstract/do-hyaluronic-acid-injections-delay-total-knee-replacement-surgery/

Physical Therapy
– Physical therapy increases natural HA production
https://onlinelibrary.wiley.com/doi/pdf/10.1002/art.1780301203

Injection Method
– Blind injections
https://www.regenexx.com/blog/areas-treated/knee/blind-knee-injections-why-is-this-procedure-still-being-performed/
https://onlinelibrary.wiley.com/doi/full/10.1002/art.27448
https://onlinelibrary.wiley.com/doi/epdf/10.1111/1756-185X.13123
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1934148211001134?returnurl=null&referrer=null
https://www.sciencedirect.com/science/article/pii/S1934148211001134
https://www.google.com/url?q=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3324992/&source=gmail&ust=1544626940051000&usg=AFQjCNEtioAPq1LPtZo2O_aywn5Y217UqQ

Performing a Diagnosis:

-Back pain does not always originate from the spine

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4926733/