The Re:PAIR Clinic
Regenerative Medicine for Pain and Injury Rehabilitation
The Evidence behind our Treatments
At The Re:PAIR Clinic, we pride ourselves on only offering safe therapeutic options that are proven to help get you back on track
Explore the evidence behind The Re:PAIR Clinic
Please click the links to explore the scientific data that supports our approach:
What is currently wrong with standard musculoskeletal care? Why do you need The Re:PAIR Clinic?
Hyaluronic Acid
Find out why we regard viscosupplementation as an invaluable tool in keeping people active
HA in Knee osteoarthritis
• A large systematic review and meta-analysis combining the results of 6,307 patients from 19 large placebo-controlled trials showed statistically significant benefit for both pain and more so function of hyaluronic acid in knee osteoarthritis. In these patients, no serious adverse effects were seen related to the treatment.
Pereira, T.V., Jüni, P., Saadat, P., Xing, D., Yao, L., Bobos, P., Agarwal, A., Hincapié, C.A. and da Costa, B.R., 2022. Viscosupplementation for knee osteoarthritis: systematic review and meta-analysis. bmj, 378. https://www.bmj.com/content/378/bmj.o2190
• A systematic review of 20,049 patients comparing hyaluronic acid viscosupplementation with NSAIDs, corticosteroid injections and placebo found clinically-relevant improved pain and function with good safety profile Campbell, K.A et al 2015. Is local viscosupplementation injection clinically superior to other therapies in the treatment of osteoarthritis of the knee: a systematic review of overlapping meta-analyses. Arthroscopy: The Journal of Arthroscopic & Related Surgery
• A systematic review and critical appraisal of Hyaluronic Acid in knee osteoarthritis by an independent, not-for-profit organisation responsible for providing Canada’s healthcare system. It found that high molecular weight, biologically fermented HA (such as the Ostenil we use at The RePAIR Clinic) with ~3 injection regimens and provides effective long term improvements in pain and function over and above corticosteroids Tran, K. and Loshak, H., 2019. Intra-articular hyaluronic acid for viscosupplementation in osteoarthritis of the hand, shoulder, and temporomandibular joint: a review of clinical effectiveness and safety.
• A systematic review and metanalysis of single injection hyaluronic acid therapy suggesting sustained pain relief in knee osteoarthritis Vincent, P., 2019. Intra-articular hyaluronic acid in the symptomatic treatment of knee osteoarthritis: a meta-analysis of single-injection products. Current Therapeutic Research, 90, pp.39-51.
HA in Hip osteoarthritis
• A systematic review and meta-analysis showing hyaluronic acid is effective at improving pain and function with increased walking distances, with ultrasound-guided injection being the safest approach. Piccirilli, E., Oliva, F., Murè, M.A., Mahmoud, A., Foti, C., Tarantino, U. and Maffulli, N., 2016. Viscosupplementation with intra-articular hyaluronic acid for hip disorders. A systematic review and meta-analysis. Muscles, ligaments and tendons journal,
HA in Ankle osteoarthritis
• A Cochrane systematic review suggests that hyaluronic acid is not better that no treatment or conservative treatment for ankle OK. The review suggests that there is uncertainty over the benefit of hyaluronic acid for the treatment of ankle osteoarthritis compared to placebo. Hyaluronic acid injections might be conditionally recommended when simple analgesics have failed Witteveen A, Hofstad C, Kerkhoffs G (2015) Hyaluronic acid and other conservative treatment options for osteoarthritis of the ankle. Cochrane Database of Systemic Reviews
HA Thumb osteoarthritis
• A systematic review and meta-analysis of injection therapies in thumb osteoarthritis found hyaluronic acid improved function from 12 weeks post-injection compared with placebo or corticosteroids. Trellu, S., Dadoun, S., Berenbaum, F., Fautrel, B. and Gossec, L., 2015. Intra-articular injections in thumb osteoarthritis: a systematic review and meta-analysis of randomized controlled trials. Joint Bone Spine, 82(5), pp.315-319. https://pubmed.ncbi.nlm.nih.gov/25776442/
Platelet-Rich Plasma
Explore why this regenerative technology, harnessing the body's own healing powers, is a valuable option in maintaining function
PRP in Knee osteoarthritis
High quality (systematic review and meta-analysis) evidence exists leukocyte-poor PRP for osteoarthritis of the knee (OA). Multiple systematic reviews and meta-analyses support the use of PRP injections specifically pertaining to knee OA (osteoarthritis) and it is supported by multiple national orthopaedic association consensus statements
Le, A.D., Enweze, L., DeBaun, M.R. and Dragoo, J.L., 2018. Current clinical recommendations for use of platelet-rich plasma. Current reviews in musculoskeletal medicine, 11, pp.624-634
Johal, H., Khan, M., Yung, S.H.P., Dhillon, M.S., Fu, F.H., Bedi, A. and Bhandari, M., 2019. Impact of platelet-rich plasma use on pain in orthopaedic surgery: a systematic review and meta-analysis. Sports Health, 11(4), pp.355-366.
An economic analysis of retrospective cohort showing that PRP therapy is cost-effective, the cost offset by the savings from function gained and reduction in pain
A retrospective observational cohort study to identify those who most benefit from PRP, identifying PRP injections led to a significant clinical improvement in middle-aged adults with a low to moderate knee osteoarthritis
A Nature published randomised control trial showing significant improvements with PRP in knee function and pain, which was more sustained than hyaluronic acid. There was also less loss of cartilage at 1 year with PRP, although this was not significant and a larger trial is needed to prove
A meta-analysis of RCTs showing the benefit of intra-articular PRP in the treatment of knee OA was clinically important when compared with intra-articular saline or corticosteroid solution injections.
An RCT showing improved pain and functional outcomes from multiple PRP injections at 1 year post-injection
A consensus statement of international experts in knee surgery and sports trauma with strong agreement that PRP is as an effective treatment especially in early or moderate knee OA
PRP in Patellar tendinopathy/Jumper’s Knee
A prospective cohort study finding significant improvements in pain and function at 6 months post PRP injection
PRP Chronic tendinopathies
A prospective cohort study showing significant improvement in pain and function at 1, 6 and 12 months with PRP therapy alongside needle tenotomy for chronic tendinopathies
PRP in Chronic Pes Anseurine pain syndrome
A prospective cohort study showing significant pain reduction with PRP in chronic pes anseurine syndrome
PRP in Elbow (lateral epicondylitis)
High quality (systematic review and meta-analysis) evidence exists for leukocyte-rich PRP injection for lateral epicondylitis
Le, A.D., Enweze, L., DeBaun, M.R. and Dragoo, J.L., 2018. Current clinical recommendations for use of platelet-rich plasma. Current reviews in musculoskeletal medicine, 11, pp.624-634.
Chen X, Jones IA, Park C, Vangsness CT Jr. The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. Am J Sports Med. 2018 Jul;46(8):2020-2032
PRP in Rotator cuff tendinopathy in the Shoulder
A meta-analysis showing that PRP is safe and effective for long-term shoulder pain symptoms and shoulder function associated with injury to the rotator cuff
A prospective cohort study showing improvements in pain, function and MRI appearances in patients with rotator cuff tendinopathy unresponsive to physiotherapy and corticosteroid injection
PRP in Partial rotator Cuff tears in the Shoulder
A meta-analysis of low bias RCTs showing longterm superiority of PRP over control therapies (including sham injection, dry needling and physio alone) in shoulder pain and function from 6 months in patients with rotator cuff tendinopathy comprising tendinosis, partial tear of rotator cuff, and impingement syndrome
Lin, M.-T.; Wei, K.-C.; Wu, C.-H. Effectiveness of Platelet-Rich Plasma Injection in Rotator Cuff Tendinopathy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Diagnostics 2020, 10, 189.
A meta-analysis showing long-term retear rates were significantly decreased in patients with rotator cuff–related abnormalities who received PRP, with small but significant improvements in multiple functional outcomes
A double-blind RCT showing improved pain and function in partial rotator cuff tears treated with PRP at 6 and 12 months, with some additional benefit if co-administered with hyaluronic acid
Cai, Y.U., Sun, Z., Liao, B., Song, Z., Xiao, T. and Zhu, P., 2019. Sodium hyaluronate and platelet-rich plasma for partial-thickness rotator cuff tears. Medicine and Science in Sports and Exercise, 51(2), p.227.
A prospective cohort study showing significant improvement in pain and function in patients with a partial (<50%) rotator cuff tear who have been non-responsive to conservative management
PRP in Achilles tendinopathy
A prospective cohort study showed significant benefit of PRP on pain and function at 18months post-injection
PRP in talar osteochondral lesions of the Ankle
A systematic review including studies on 160 ankles showing platelet-rich plasma significantly improved pain and function outcomes in patients with osteochondral lesions of the talus
Yausep, O.E., Madhi, I. and Trigkilidas, D., 2020. Platelet rich plasma for treatment of osteochondral lesions of the talus: a systematic review of clinical trials. Journal of Orthopaedics, 18, pp.218-225
Arthrosamid
Find out why this innovative therapeutic option has the potential to return function to many people who previously had few options available
Knee osteoarthritis
A pilot study - Hartkopp 2015 - Injection of non-degradable polyacrylamide gel into the knee joint shows long-term beneficial effect on OA symptoms
Guided Steroid injections
Corticosteroids give long-established benefits in musculoskeletal care:
1.Reduce the inflammatory cascade1
2.Provide pain relief in patients suffering from inflammatory orthopaedic conditions2
3.By above mechanism, support QoL and periarticular ROM/strength/rehab potential
1. Barnes PJ. How corticosteroids control inflammation: Quintiles Prize Lecture 2005. Br J Pharmacol. 2006;148:245–54.
2. Hollander JL, Brown EM Jr, Jessar RA, Brown CY. Hydrocortisone and cortisone injected into arthritic joints; comparative effects of and use of hydrocortisone as a local antiarthritic agent. J Am Med Assoc. 1951;147:1629–35.
However, there is rightfully rising concern about their use:
1.Local soft tissue toxicity – AAOS 2013 “unable to recommend for or against” IACS in OA knee3
2.More recent questions raised re: articular tissue destruction, increased infection risk, and increased surgical revision rates associated with periop IACS timing and frequency4-6
3. Jevsevar DS. Treatment of osteoarthritis of the knee: evidencebased guideline, 2nd edition. J Am Acad Orthop Surg. 2013;21: 571–6.
4. Wernecke C, Braun HJ, Dragoo JL. The effect of intra-articular corticosteroids on articular cartilage: a systematic review. Orthop J Sports Med. 2015;3:2325967115581163.
5. Weber AE, Trasolini NA, Mayer EN, Essilfie A, Vangsness CT Jr, Gamradt SC, et al. Injections prior to rotator cuff repair are associated with increased rotator cuff revision rates. Arthroscopy. 2019;35:717–24.
6. Wang D, Camp CL, Ranawat AS, Coleman SH, Kelly BT, Werner BC. The timing of hip arthroscopy after intra-articular hip injection affects postoperative infection risk. Arthroscopy. 2017;33:1988–94 e1981.
Fluorinated corticosteroids increase the risk of tendon rupture:
1.Fluorination – decreases solubility further, but increases risk of tendon rupture and s/c atrophy8-9
As as type, and indication for use, tisse-specific location is also important: