Platelet-rich plasma in orthopaedic sports medicine: state of the art

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Abstract

Platelet-rich plasma (PRP) is one of the many new developments within the expanding field of regenerative medicine. It aims to improve the process of tissue repair through local delivery of autologous bioactive agents to influence critical physiological mechanisms such as inflammation, angiogenesis or extracellular matrix synthesis. Within orthopaedics and sports medicine, the use of PRP has been rapidly increasing in popularity as patients seek non-surgical approaches to acute and chronic musculoskeletal injury and disease. The popularity of this new treatment option has prompted a rapid increase in research endeavours. Although preclinical studies were encouraging, clinical studies often reported controversial results. The differences in the composition and application techniques of PRP have made comparisons regarding its efficacy difficult and somehow inconclusive. Although PRP appears to be a safe treatment option with potentially beneficial effects to injured musculoskeletal tissues, continuous efforts are needed to identify factors that influence the biological response to PRP treatment. It is likely that in the near future the PRP preparation will be tailored not only to the specific pathology of interest but also to stage of disease. However, the growing emphasis on an evidence-based approach in the sports medicine setting demands additional research efforts before incorporating this technology in routine clinical care. The current review explores the latest findings on PRP efficacy in several musculoskeletal conditions, focusing on results of the highest level of evidence available.

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Platelet-rich fibrin (PRF): a second-generation platelet concentrate. Part III: leucocyte activation: a new feature for platelet concentrates?

David Dohan, Joseph Choukroun, Antoine Diss … (2006)

Platelet-rich fibrin (PRF) belongs to a new generation of platelet concentrates, with simplified processing and without biochemical blood handling. In this third article, we investigate the immune features of this biomaterial. During PRF processing, leucocytes could also secrete cytokines in reaction to the hemostatic and inflammatory phenomena artificially induced in the centrifuged tube. We therefore undertook to quantify 5 significant cell mediators within platelet poor plasma supernatant and PRF clot exudate serum: 3 proinflammatory cytokines (IL-1beta, IL-6, and TNF-alpha), an antiinflammatory cytokine (IL-4), and a key growth promoter of angiogenesis (VEGF). Our data are correlated with that obtained in plasma (nonactivated blood) and in sera (activated blood). These initial analyses revealed that PRF could be an immune regulation node with inflammation retrocontrol abilities. This concept could explain the reduction of postoperative infections when PRF is used as surgical additive.

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Treatment of chronic elbow tendinosis with buffered platelet-rich plasma.

T Pavelko, Allan Mishra (2006)

Elbow epicondylar tendinosis is a common problem that usually resolves with nonoperative treatments. When these measures fail, however, patients are interested in an alternative to surgical intervention. Treatment of chronic severe elbow tendinosis with buffered platelet-rich plasma will reduce pain and increase function in patients considering surgery for their problem. Cohort study; Level of evidence, 2. One hundred forty patients with elbow epicondylar pain were evaluated in this study. All these patients were initially given a standardized physical therapy protocol and a variety of other nonoperative treatments. Twenty of these patients had significant persistent pain for a mean of 15 months (mean, 82 of 100; range, 60-100 of 100 on a visual analog pain scale), despite these interventions. All patients were considering surgery. This cohort of patients who had failed nonoperative treatment was then given either a single percutaneous injection of platelet-rich plasma (active group, n = 15) or bupivacaine (control group, n = 5). Eight weeks after the treatment, the platelet-rich plasma patients noted 60% improvement in their visual analog pain scores versus 16% improvement in control patients (P =.001). Sixty percent (3 of 5) of the control subjects withdrew or sought other treatments after the 8-week period, preventing further direct analysis. Therefore, only the patients treated with platelet-rich plasma were available for continued evaluation. At 6 months, the patients treated with platelet-rich plasma noted 81% improvement in their visual analog pain scores (P =.0001). At final follow-up (mean, 25.6 months; range, 12-38 months), the platelet-rich plasma patients reported 93% reduction in pain compared with before the treatment (P <.0001). Treatment of patients with chronic elbow tendinosis with buffered platelet-rich plasma reduced pain significantly in this pilot investigation. Further evaluation of this novel treatment is warranted. Finally, platelet-rich plasma should be considered before surgical intervention.