03/24/2017     David Zuckerman, DPM

Amnion Injections: Evaluating a Brave New World of Regenerative Sports Medicine

I have read with interest Dr Pearl's article on
Amnion injections for degenerative conditions.
featured by PM News. There appears to be a false
statement that quantifiable long-term outcomes
have not been reported with ESWT treatments. I
have enclosed an abstract by Professor Wang which
was done with long-term conclusions outlined.

Below is the portion from Dr. Pearls article
indicating that ESWT doesn't have long-term
outcome. This is absolutely incorrect. again see
just one abstract by Professor Wang.

Quote from Dr. Pearl's Featured Article
Amnion injections: "Intrasubstance tears,
tendinosis, and mucoid-myxoid degeneration are
difficult to treat successfully without involving
surgical methods. The current advancements in
modern biotechnology have offered options to
surgical repair with other minimally invasive
techniques that have not provided quantifiable
long term outcomes, such as extracorporeal shock
wave therapy, radiofrequency-coblation, etc."

ESWT high energy by Dornier and Osstron devices
both have shown long-term resolution of plantar
fasciosis... here is just one example of a study
over a 60-72 months. This is considered long-
term. See abstract below. .

Wang et al. (2006) compared results of high-
energy ESWT (n = 79 patients, 85 heels) vs.
conservative treatment (n=70 patients, 83 heels)
for plantar fasciitis. Patients in the shockwave
group received 1500 impulses at 16 kV (0.32 mJ/mm
2) in a single session. Patients in the control
group received conservative treatment consisting
of non-steroidal anti-inflammatory drugs,
orthotics, physical therapy, an exercise program,
and/or a local cortisone injection. Patients were
evaluated with a 100 point scoring system with 70
points for pain and 30 points for function.

Before treatment, the groups had no significant
differences in the scores for pain and function.
The shockwave group was evaluated at 60 to 72
months; the conservative treatment group was
evaluated at 34 to 64 months. Overall results for
the shockwave group were 69.1% excellent, 13.6%
good, 6.2% fair, and 11.1% poor.

Overall results for the control group were 0%
excellent, 55% good, 36% fair, and 9% poor. The
shockwave group had a recurrence rate of 11%; the
control group had a recurrence rate of 55%. There
were no systemic or local complications. The
study weaknesses include evaluations that were
performed at different follow-up times and 70% of
the score was subjective.

David Zuckerman, DPM, Cherry Hill, NJ

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