SLR - July 2019 - Emlyn Forsung
Reference: Ali Moshiri, Ahmad Oryan, Abdolhamid Meimandi-Parizi, Synthesis, Development, Characterization and Effectiveness of Bovine Pure Platelet Gel-Collagen-Polydioxanone Bioactive Graft on Tendon Healing. J Cell Mol Med. 2015 Jun; 19(6): 1308-1332. Published online 2015 Feb 20. doj: 10.1111/jcmm.12511Scientific Literature Review
Reviewed By: Emlyn Forsung, DPM
Residency Program: East Liverpool City Hospital – East Liverpool, OH
Podiatric Relevance: This article presents an interesting option for treatment of acute tendon ruptures. It attempts to introduce an off the shelf product with similar or even better efficacy than PRP in treatment of tendon injuries. The authors hypothesize that the Bovine Platelet Gel (PBG) and its growth factors may regulate inflammation at short-term, trigger fibroplasia and remodeling at mid to long-term respectively and help accelerate tendon regeneration.
Methods: This is an animal-based study conducted on New Zealand rabbits aged 12-14 months. A 2 cm section of the Achilles tendon with the covering paratenon was completely excised by transverse incisions. Collagen type I was extracted from the bovine tendon, purified and made into a scaffold. BPG was used to surgically repair the tendon defect and this was compared with collagen implant (CI), CI with PDS. Animals were evaluated at 60 and 120 days.
Results: This study showed how effective BPG can be in acute tendon injury in animal studies. Treatment with BPG significantly enhanced the scoring values for the development of peritendinous adhesion, significantly increased transverse diameter and density of the collagen fibrils, fibers and fiber bundles, and also it sooner differentiated the collagen fibrils to fibers and fibers to fiber bundles compared to the controls. BPGs, when embedded within CI-PDS (artificial tendon),significantly enhances cytocompatibility of the implant at in vitro level and also improves scaffold biocompatibility and biodegradability in vivo.
Conclusions: The authors showed that BPG was superior to PRP and releases more growth factors than PRP. My conclusion from this article is that there will be a reluctance in implementing this product in day to podiatry practice. This is because PRP is readily available and will be significantly cheaper. Not only this, but PRP has also been shown to be effective in facilitating tendon healing. Being from the patient, PRP has no chance of host reaction. Even though this study shows that BPG has a great potential, it will be have to be tested in humans in clinical trial setting. Most podiatric surgeons will be reluctant to try a product which has not being tested and approved by the FDA.