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PRP and Hyaluronic Acid. Are they better together?

        Dr A Ibrahim

        March 2022

The following articles written by Dr Ibrahim address the use of PRP and Hyaluronic Acid and how effective they can be when combined. 

Knee Osteoarthritis: Maximising the non-surgical approach

        Dr A Ibrahim

        February 2019

The following articles was written by Dr Ibrahim and outlines the use of Hyaluronic Acid as a treatment for osteoarthritis. 

Long-Term Safety of Using Local Anesthetic Injections in Professional Rugby League for Modified Indications

        S. Sebak, J. Orchard, L. Golding, E. Steet, S. Brennan, A. Ibrahim

        5 October 2019


Objective: To assess and evaluate the long-term safety of local anesthetic injections before or during games in professional rugby league players.

Participants: Sydney Roosters players over a 6-year period (2008-2013), who had been administered a local anesthetic injection for an injury before or during a match to aid return to play.

Main Outcome Measures: Player self-reported satisfaction. Survey results were compared with a previous cohort who had received local anesthetic injection from 1998 to 2007.

Results: Thirty-two players who had been injected with local anesthetic on 249 occasions for 81 injuries completed the current survey at an average of 5.64 years post-injection. In the cohort of 2008 to 2013, fewer injections were performed to areas deemed higher risk compared with the 1998 to 2007 cohort (P < 0.00002). The vast majority of players (80/81 cases) would repeat the injection in the same circumstances and reported that ongoing side effects were uncommon. There were 6 cases (8%) in which players reported significant ongoing pain in the area of injection at long-term follow-up.

Conclusion: This study affirmed the long-term safety of injections in most cases

Improvement in condition-specific and generic quality of life outcomes in patients with knee osteoarthritis following Synvisc-One: Results from the LOBRAS study

         E. Barui, S. Burne, R. Cooke, M. Craig, P. Dalton, M.Dekkers, J.Edelman, S. Fine, G.Gamboa, S. Hall, A. Ibrahim, C. Inderjeeth, K.

         LimM.Mazur, D.A.F. Morgan, P. Myers, A. Nicoll, R. Paterson, M. Shanahan, A. Stockman and S. Watson

         December 2016


Objective: To evaluate the effectiveness of viscosupplementation with Synvisc-One in knee Osteoarthritis (OA), during routine clinical care, in a 52 week observational study.

Main outcome measures: Western Ontario and McMaster (WOMAC) OA Index, and the Short Form 36 questionnaire (SF-36 v2).

Results: 131 patients with knee OA were enrolled, of whom 119 provided both pre- and post-intervention WOMAC data. Statistically significant improvements (with a maximum of p ≤ .025) from baseline to Week 12, Month 6 and Week 52 were detected, by intention-to-treat (ITT) and per-protocol (PP) analyses, in WOMAC Pain, Stiffness, Function, PGA, and Total Score, SF-36 PCS, and WOMAC-derived HUI3. Adverse events (AEs) monitoring detected treatment-related AEs in 5.3% of patients.

Conclusions: The effectiveness of Synvisc-One in routine clinical care is supported by the detection of statistically significant, clinically important improvements in WOMAC Pain, Stiffness, Function, Total, and PGA outcomes, and statistically significant improvements in SF-36 PCS and WOMAC-derived HUI3 outcomes at multiple time points. Limitations of this study include lack of a control group or blinding. No predictive indicators of the response to treatment were identified. In general Synvisc-One was well tolerated with very few patients experiencing any Synvisc-One related adverse events. Collectively, these observations attest to the effectiveness of Synvisc-One and complement previous observations in routine clinical care.

Long-term safety of using local anesthetic injections in professional rugby league 


             John W Orchard 1Elizabeth SteetAndrew MasseySommit DanBen GardinerAmeer Ibrahim

             July 2010


Background: Local anesthetic pain-killing injections are commonly used by some professional football teams to allow continued play for certain injuries; however, the long-term safety of this practice has not been studied.

Hypothesis: The majority of local anesthetic injections administered in professional football are helpful and safe, not leading to long-term sequelae.

Study design: Case series; Level of evidence, 4.

Methods: A retrospective survey was conducted of 100 players over 10 seasons who had been injected with local anesthetic on 1023 occasions for 307 injuries (81% follow-up; average follow-up, 5 years; minimum, 1 year). A comparison of match performance statistics was made from 3 seasons between players using and not using local anesthetic.

Results: The majority (98%) of players would repeat the procedure if they had their injury again, although 32% felt that there were side effects associated with the procedure (including 22% who thought that the recovery of the primary injury was delayed and 6% who thought that the injury was worsened by playing with local anesthetic). On long-term follow-up, only 6% of players had significant residual pain in the body part injected. The satisfaction rates for acromioclavicular injuries, finger injuries, rib injuries, and iliac contusions were higher than for sternum injuries, wrist injuries, and ankle injuries. Player performance between those players injected and not injected with local anesthetic was not substantially different and mainly reflected a positional bias for the players who used local anesthetic.

Conclusion: The most commonly injected injuries-acromioclavicular joint sprains, finger and rib injuries, and iliac crest contusions-appear to be quite safe (in the context of professional sport) to inject at long-term follow-up. Conversely, ankle, wrist, and sternum injections appear to be less safe. A few injuries may have been substantially worsened by playing after an injection.

Adductor strain and hip range of movement in male professional soccer players

         A. Ibrahim, G. Murrell, P. Knapman

        April 2007


Purpose. To determine whether hip range of movement (ROM) can predict the occurrence of adductor strain among male professional soccer players.


Methods. 120 subjects were prospectively selected from 6 professional soccer clubs in Australia. Internal rotation, external rotation, and ROM of the hip were measured using a goniometer before and during the course of a soccer season (2003–2004). When adductor strain occurred, further assessments of the hip were performed. Injured subjects’ hip ROMs were measured again at the end of the season.

Results. Eight of the 120 subjects had 9 adductor strains (one bilateral). There was a correlation between preseason decreased hip ROM and occurrence of adductor strain. The mean preseason hip ROM was 44.7 degrees in the injured group and 53.7 degrees in the uninjured group. Once the subjects were able to resume playing soccer, their hip ROM increased to near pre-injury levels.


Conclusion. Decreased hip ROM may be considered an aetiological factor in the occurrence of adductor strain in male professional soccer players.

Case Report: Hamstring muscle strain injury caused by isokinetic testing

         J. Orchard, E. Street, C. Walker, A. Ibrahim, L. Rigney, M. Houang

        September 2001

Introduction. This case involves a professional rugby league player who suffered a magnetic resonance imaging (MRI)- proven primary right hamstring injury, caused by an eccentric isokinetic Kin-Com test.



Eccentric isokinetic testing carries a risk of muscle strain injury. Athlete perception of this risk may affect the reliability of this form of testing

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