Platelet rich plasma (PRP) is a concentrate of platelets and their bioactive factors derived from the peripheral venous blood of patients. Platelets contain factors that improve healing and tissue regeneration. PRP may offer an excellent means of non-operatively treating foot and ankle pathology. Objectives: to determine whether PRP injections improve outcomes for foot and ankle pathologies. Methods: A retrospective cohort study of patients aged ≥ 18 years diagnosed with foot or ankle pathology at University of California San Diego between January 2011 and September 2016 was performed. Patients treated with an intra-articular injection using platelet-rich plasma were categorized into the PRP group. Age and gender matching were used to select active comparator group (triamcinolone injection), and a control group (conservative treatment). Primary outcomes were patient-reported pain and function before treatment and at 12 weeks post-treatment. Pain ranged from 1-10 with higher scores corresponding to higher perception of pain. Function was determined by patient-reported activity limitations and scored according to the Amerian Orthopedic Society Foot and Society (AOFAS) ankle hindfoot scale. High scores corresponded to better function. Results: we identified four patients that met inclusion criteria for the PRP group (n=4), with age and gender matching for tiramcinolone (n=4), and control (n=4). Patients averaged 41 years old, (range 26-61), were 75% female, and had an average BMI of 28.9 (range 19.7-44.3). The median pain score before and after treatment did not change significantly after 12 weeks in the PRP group (95% CI-1,8; P=0.19), triamcinolone group (95% CI-7,5; P=.88), or the control group (95% CI-1,7; P=.08). Functional scores before and after treatment did no significantly change after 12 weeks in the PRP group (95% CI-3,0; P=.058), triamcinolone group (95% CI-6,3; P=.74), or the control group (95% CI-6,6; P=1). There was no significant difference in change of pain or change of function between PRP, triamcinolone, and conservative therapy (P=.31, P=.09, respectively). Conclusion: among patients with foot ankle pathologies at UCSD, PRP did not result in greater improvement in pain or function at 12 weeks post-treatment compared to triamcinolone or conservative treatment.

Tuberculosis (TB) is often difficult to diagnose in immunocompromised patients and occurs 20 to 74 times more frequently in recipients of solid organ transplants than in the general population. We present the case of a 40-year-old female immigrant from Mexico previously treated for latent TB who underwent a simultaneous pancreas and kidney transplant. She experienced 3 episodes of rejection and then presented with 4 months of nonspecific abdominal pain. She was ultimately diagnosed with disseminated TB presenting with intestinal perforation and pulmonary involvement. This case illustrates the need for clinicians to maintain a high index of suspicion for TB in transplant recipients, especially those previously treated for TB or rejection.