Arthrex ACP® Double Syringe

Autologous Conditioned Plasma

Introduction

Autologous blood products have created a growing interest for use in a number of therapies. The healing effects of plasma are supported by growth factors released by platelets. These growth factors induce a healing process wherever they are applied.

Features and Benefits

  • The ACP (Autologous Conditioned Plasma) double syringe allows rapid and efficient concentration of platelets and growth factors from autologous blood, for use at the treatment site.
  • The unique double syringe design allows a convenient and safe handling, as the whole preparation process takes place in a closed system.
  • The ACP System is more affordable, easier to use, and has a quicker procedure time when compared to other conventional PRP (platelet-rich plasma) devices.
  • White and red blood cells are not concentr ated within the ACP system. These cells can cause a detrimental effect on the healing process due to release of degradative proteins and reactive oxygen species.
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Directions for use

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Prior to withdrawing anticoagulant, prime the innermost syringe by pulling it back and pushing it forward completely before starting the process. Withdraw approximately 1.5 ml anticoagulant into the syringe.

Note: If ACP is going to be used within thirty minutes of blood withdrawal, the use of anticoagulant is not required.

Caution: Draw back only the plunger of the outer syringe (red marking).

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Slowly withdraw by pulling back on the wings that are colored red. F ill the syringe to a maximum of 16 ml of venous blood at a rate of 1 ml every two seconds and seal the syringe with the red cap.

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Gently rotate the syringe in order to mix the blood and the anticoagulant.

Place the syringe into one bucket and an appropriate size counterweight in the opposite bucket.

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For equine, run the centrifuge at 1100 rpm for five minutes. For canine, run the centrifuge at 1300 rpm for fi ve minutes. Remove the syringe, taking care to keep it in an upright position to avoid mixing the plasma and red blood cells.

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In order to transfer 4-7 ml of ACP from the larger outer syringe into the small inner syringe, slowly push down on the outer syringe´s red wings, while slowly pulling up the plunger of the small inner syringe.

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Unscrew the small inner syringe and place an injection needle on to it. The ACP is ready for use at the point of care.

The ACP can also be transferred into a sterile cup on the sterile field. The ACP should be used within four hours after the blood draw when anticoagulant is used and within 30 minutes without anticoagulant.

Clinical and Surgical Applications

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Intra-tendonous Therapy

Acute or chronic tendonitis and tendonopathy can be treated with PRP injections. PRP can also be used to augment any tendon repair procedure intraoperatively. PRP has been demonstrated to increase anabolic and extracellular matrix gene expression, induce cell proliferation, improve neovascularization, advance range of motion, and promote early recovery through a number of in vitro, in vivo and clinical studies with respect to tendon therapies.

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Intra-articular Therapy

PRP has shown some significant promise with respect to intra-articular therapy for treatment of cartilage, the meniscus and the disease of osteoarthritis. Studies have been able to describe PRP as a method to increase chondrocyte extracellular matrix production, synovial hyaluronic acid production and improve patient pain/function for osteoarthritis. Osteoarthritis is a catastrophic joint disease that severely affects clients within veterinary practices. Having the potential to pro vide an autologous therapeutic solution to help remedy pain associated with this disease becomes an advantageous option.

Mechanism of action

Outside the bloodstream, platelets become activated and release proliferative and morphogenic proteins. These growth factors are known to be relevant for healing in a variety of tissue types.1,2 They appear to work synergistically to invoke the following benefits.

  • Induce proliferation and differentiation of various cell types (e.g., stem cells, osteoblasts, epidermal cel ls)
  • Enhance/modulate production of collagen, proteoglycan and tissu e Inhibitor of Metalloproteinases (TIMP)
  • Stimulate angiogenesis and chemotaxis

In order to evaluate the differences between ACP and whole blood, ACP was prepared from the venous blood of 12 healthy human donors and the concentration of platelets, red blood cells (RBC), and white blood cells (WBC) were measured with a standard CBC. We found the density of platelets to be more than twice as high in the ACP vs. whole blood. The concentration of inflammatory white and red blood cells in w hole blood vs. ACP were drastically reduced by 10.3x and 99.4x, respectively.

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In order to determine the effect ACP has on particular cell lines, in vitro culture work was done with tenocytes, osteoblasts, and myocytes. Peripheral blood was obtained from eight donors and proliferation of the cell lines were measured for the following five culture groups: (1) negative control, cells cultured with 2% or 5% fetal bovine serum (FBS); (2) positive/proliferative control, cells cultured with 10% or 15% FBS; (3) whole blood; (4) a buffy coat-based PRP system containing 7x platelet concentration and 4x WBC concentration; and (5) ACP. An ANOVA statistical analysis was completed to compare the different culture groups. ACP resulted in an increase in proliferation that was statistically significant (p < 0.05) over the negative control, positive control, and whole blood culture groups for each of the three cell lines. ACP induced proliferation was also statistically greater than the buffy coat-based PRP culture group for the osteoblast and myocyte cell lines. ACP was not statistically different from the buffy coat PRP for tenoctyes, but it did approach significance and had an increased proliferative mean.

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The increased proliferation for ACP vs. the other four groups could be caused by a number of factors. There may be a cellular dose response indicating that only a certain level of growth factors released from platelets are needed in order to elicit maximum proliferation.

After reaching this proposed threshold, over concentrating platelets and growth factors may cause a paradoxical inhibitory effect on cell proliferation. The inclusion of WBCs, specifically neutrophils, within a PRP product ma y prevent maximal growth potential due to release of degradative enzymes and reactive oxygen species. Overall, this in vitro study demonstrates that ACP is the ideal PRP for cellular proliferation when compared to a buffy coat-based PRP.

ORDERING INFORMATION

PPS Natrium-Citricum 3.13% - 10 ml

PZN-3195010

Arthrex ACP Double Syringe

VABS-10014

Centrifuge Hettich Rotofix 32 with Swing Out Rotor, 220 V

VABS-10020

Bucket with Screw Cap

VABS-10022

Counterweight for Centrifugation of ACP Double Syringe, 15 ml

VABS-10027

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