UNITA OPERATIVA COMPLESSA DI RADIOLOGIA OSPEDALE CIVILE DELLANNUNZIATA

UNITA’ OPERATIVA COMPLESSA DI RADIOLOGIA OSPEDALE CIVILE DELL’ANNUNZIATA COSENZA DIRECTOR DOCTOR CASIMIRO GIANNUZZI

UNITA’ OPERATIVA INTERDIPARTIMENTALE DI RADIOLOGIA VASCOLARE ED INTERVENTISTICA DIRECTOR DOCTOR GIAMPIERO GUIDO

Use of PRP at the Ospedale Annunziata di Cosenza for the treatment of tendon pathologies DOCTOR HESHAM ALMOLLA

PARTICIPANTS IN OUR EXPERIENCE • DEPARTMENT OF RADIOLOGY • DEPARTMENT OF VASCULAR AND INTERVENTIONAL RADIOLOGY • DEPARTMENT OF ORTHOPEDIC SURGERY • HAEMOTRANSFUSION CENTRE

GEL PIASTRINICO NOSTRA ESPERIENZA DOCTR HESHAM ALMOLLA DOCTOR ENRICO COSTABILE DOCTOR MARCELLO NAPOLITANO

SIMTI-Calabria 1° CONVEGNO CALABRESE “I FATTORI DI CRESCITA PIASTRINICI NELLA RIGENERAZIONE TISSUTALE” Cosenza, 10 -11 Giugno 2011 – Sala degli Specchi, Palazzo della Provincia Presidenti: Dott. Marcello Bossio Dott. Francesco Togo Dott. Casimiro Giannuzzi Segreteria Scientifica: Dott. M. Napolitano Dott. A. Crescibene Dott. E. Costabile Dott. H. Almolla Dott. ssa R. Bosco

OUR DIFFICULTIES

ITALIAN LAWS THAT REGULATES HAEMOCOMPONENTS MANAGEMENT • Legge 219/2005. • “Nuova disciplina delle attività trasfusionali e della produzione nazionale di emoderivati” • D. M. 3 Marzo 2005 • “Emocomponenti topici”…assicurato da strutture sanitarie specializzati: Centri Trasfusionali… • Direttiva 2002/98/CE Parlamento del Consiglio d’Europa • DL 191 Agosto 2005 DL 216 Dicembre 2007 • “che stabilisce norme di qualità e sicurezza per la raccolta, il controllo, la lavorazione, la conservazione e la distribuzione del sangue umano e dei suoi componenti, “…a qualunque uso siano destinati…”

PRACTICE TARGETS • Construction of an integrated multidisciplinary practice • Spacial and temporal optimization of human and technological resources • Adequate response to the territory health needs • Reduction of articular degenerative pathology management costs

Paper work patient record card includes • Name, sex, age, telephone number and occupation • Level of physical activity: nil, moderate, elevated • Prior therapies undertaken • Duration of symptoms

Clinical evaluation • NRS and VISA scores • AP and LL tendon diameters on base line, end of injection cycle and one month follow-up ultrasound examinations • Controlateral tendon taken for confrontation when asymptomatic

Chronic tendinopathy • Angiofibroblastic degeneration • Absence of inflamatory response • Poor vascularisation

Beneficial effects of PRP • • Flogosis Osteogenesis Wound healing processes Analgesics need reduction

Patient selection • • • Patient record card registration Orthopedic clinical evaluation Diagnostic imaging evaluation Haematologica evaluation NRS and VISA determination

Patient selection relative contra-indications • • History or present cancer Acute infection Platelet count < 105/ l Patient haemoglobin < 10 g/dl Anticoagulant therapy Pregnancy Mothers in nursing

Patient selection possibile adverse effects • Temporary worsening of symptoms due to the inflamatory response following tendon injection • Iatrogenic sepsis • Non analgesic response • Neurovascular injury • Hypertrofic scar or calcifications at the injection site

PRP preparation • 8 ml of autologous venous blood are drawn • Centrifugation at 3100 rpm for 8 minutes in dedicated vial (Regen lab) • Isolation of platelet rich plasma • 10 % calcium gluconate is added to the plasma before injection

Injection procedure • 22 G spinal needle • Injection below, inside and above the tendon substance • Ultrsound guidence • 10 to 15 minutes patient observation before discharge • Follow-up

PRP injection, tendinopathy protocol • Four weekly ultrsound guided injections • Weekly evaluation with B-mode ultrsound and Power Doppler • One, six and twelve months follow-up with clinical and ultrasound evaluation

OUR DATA WORK IN PROGRESS • • Functioning weekly pratice since august 2010 16 ruptured Achillis tendons treated 15 Achillis tendinopathy 6 rotuleous tendinopthy 3 sovraspinatus 5 elbow common extensor enthesis 350 knee joint, 170 hip joint, 15 trapezio-metacarpal joint, 14 ankle joint and 5 toe metacaro-phalangeal joint treated