Regenerative Medicine

Percutaneous needle tenotomy or dry needling consists of creating small fenestrations (holes) in the tendons or ligaments using a medium gauge needle.

This procedure causes the injected area to bleed, thus providing the growth factors necessary for tendons and ligaments to heal.

When we use prolotherapy or PRP injection techniques, we indirectly do dry needling.

Prolotherapy with hyperosmolar dextrose (concentration of 12.5-15%) is an injection composed of dextrose (sugar), lidocaine (anesthetic) and physiologic salin solution. Hyperosmolar dextrose injections stimulate the repair of ligaments, tendons and joints. They also increase their strength. Injections are given every 3 to 6 weeks, and a maximum of six treatments is recommended. The 3-6 week interval is the time required for collagen repair and represents the natural inflammatory process and healing.

The term prolotherapy means therapy that allows to proliferate. Years ago, prolotherapy doctors used several types of irritants to create the inflammation necessary for healing. Some of these irritants are dangerous if injected incorrectly. These dangerous substances are no longer used. Dextrose alone has proved to be effective and above all, safe.

Dextrose is used at a concentration of 12.5-15%. Its concentration becomes irritating to the tissues, thus triggers the healing process (see inflammatory cascade below). Like PRP (Platelet-Rich Plasma) injections, dextrose injections stimulate cell proliferation and self-healing. It is however much less expensive than the PRP.

See fees

 

Advantages of prolotherapy (injections of hyperosmolar dextrose)

Prolotherapy is inexpensive and readily available. It’s very safe, especially when compared to cortisone injections and regular anti-inflammatory drugs. It is regenerative (ligaments and tendons) and not only analgesic. Patients who receive dextrose injections can quickly return to normal activities, in comparison to those who receive PRP.

Download post-prolotherapy injection tips here.

 

What conditions can be treated with prolotherapy?

• Osteoarthritis of the knee
• Osteoarthritis of the hip
• Muscle tears
• Tendinopathy of the rotator cuff
• Tendinopathy of elbow
• Tendinopathy of the gluteus medius
• Tendinopathy of the hamstrings or adductors
• Patellar tendinopathy (knee)
• Achilles tendinopathy
• Plantar fasciitis (arch of the foot)
• Sequelae of sprain (ankle or knee for example)

 

Some articles and studies to read

Metaanalyses

Prolotherapy: A Clinical Review of its Role in Treating Chronic Musculoskeletal Pain, Laura M. Distel, MD, Thomas M. Best, MD, PhD

Dextrose Prolotherapy : A Narrative Review of Basic Science, Clinical Research, and Best Treatment Recommendations, Kenneth Dean Reeves, MD, Regina W.S. Sit, MD, David P. Rabago, MD

A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain, Ross A. Hauser, Johanna B. Lackner, Danielle Steilen-Matias, and David K. Harris

Prolotherapy in Primary Care Practice, David Rabago, MD, Andrew Slattengren, DO, and Aleksandra Zgierska, MD, PhD

Securité

Side Effects and Adverse Events Related to Intraligamentous Injection of Sclerosing Solutions (Prolotherapy) for Back and Neck Pain- A Survey of Practitioners, Simon Dagenais, DC, PhD, Oladele Ogunseitan, MPH, PhD, Scott Haldeman, DC, MD, PhD, James R. Wooley, DC, Robert L. Newcomb, PhD

What is the PRP?

The term PRP stands for platelet-rich plasma. PRP is composed of a high concentration of blood platelets. We produce this high concentration, thanks to the centrifugation of your platelets at the clinic (blood spinning).

 

How does the PRP work?

Platelets contain growth factors that can stimulate the healing of tissue. The goal of PRP injections is to promote the healing of injured tissue by stimulating your body’s natural healing cascade.

 

What conditions can PRP treat?

• Osteoarthritis of the knee
• Osteoarthritis of the hip
• Muscle tears
• Tendinopathy of the rotator cuff
• Tendinopathy of elbow
• Tendinopathy of the gluteus medius
• Tendinopathy of the hamstrings or adductors
• Patellar tendinopathy (knee)
• Achilles Tendinopathy
• Plantar fasciitis (arch of the foot)

 

What is the PRP injection procedure?

The injection appointment lasts up to one hour. You must be accompanied during this procedure. Dr. Ducasse takes a blood sample and puts your blood in the centrifuge at a given speed. This separates your red and white blood cells from your platelets.

Once the centrifugation is complete, platelet-rich plasma is removed from the tube and reinjected into the injured tissue or joint. The procedure is done with ultrasound guidance in a sterile manner.

During the injection, your platelets, now more concentrated, release several growth factors. This release can create inflammation and pain, but that is what allows healing. The whole procedure is done at Dr. Ducasse’s office.

 

How many treatments will I need?

The response to treatment varies from patient to patient. Some patients require a second treatment, but rarely a third.

A follow-up by phone is planned with Dr. Ducasse, 8 weeks post-injection. 

 

What are the possible side effects ?

There are very few side effects since this is a natural technique where your own blood is used. The most common side effect is increased pain following the injection. This pain can last up to two weeks in rare cases.

The acute inflammation is necessary for the tissue to heal. Sometimes, you may not feel any pain, but the tissue is still healing. The risk of infection and allergy to lidocaine (anesthetic) is very rare. A clot could form or a nerve could be touched.

The risk of deterioration of your condition or the risk of tissue rupture is very low. It is necessary to respect the post-injection recommendations.

 

What are the recommendations following this intervention?

You should avoid anti-inflammatory drugs (including Advil and Motrin) and cortisone one week before and one week after the procedure. It is useful to start a physiotherapy rehabilitation program two weeks after the treatment.

Sports activities specifically using the treated area are usually not allowed for two to three months depending on your response to the treatment.

 

When should I consider this procedure?

Usually, this treatment is reserved for cases that have not had satisfactory results with conventional treatment (anti-inflammatory, physiotherapy, cortisone injection, rest, etc.)

On the other hand, with the current knowledge we have of the multiple side effects of cortisone, patients may decide to prioritize the use of regenerative medicine by injecting PRP.

 

What should I do if I want to receive this treatment?

You must make an appointment with Dr. Ducasse. You do not need a referral ro meet her. She conducts an evaluation during the first interview and tell you if you are a good candidate for the treatment.

 

Before this first meeting, Dr. Ducasse must receive:

Any radiological report that you consider relevant for the assessment of your condition (magnetic resonance, X-ray, ultrasound, etc.)

By email (unsecured) or by fax (secure): info@dreducasse.com | 514 768-4846

 

Download post platelet-rich plasma injection tips (PRP).

Dr Ducasse do not inject stem cells yet because the international medical community still does not agree on the best way to collect stem cells (bone marrow vs. fatty tissue). In addition, there are no markers available for clinical use to identify what types of cells are being removed during sampling. Are these cells still alive or not after being harvested? How many cells are removed? How many cells do we need for optimal performance? Only research laboratories have the ability to accurately identify the injectable cells.

Finally, Health Canada has not yet approved this treatment.