Platelet-Rich Plasma: From Basic Science to Clinical Applications

Boston University School of Medicine, Boston, MA 02118, USA.
The American Journal of Sports Medicine (Impact Factor: 4.36). 11/2009; 37(11):2259-72. DOI: 10.1177/0363546509349921
Source: PubMed


Platelet-rich plasma (PRP) has been utilized in surgery for 2 decades; there has been a recent interest in the use of PRP for the treatment of sports-related injuries. PRP contains growth factors and bioactive proteins that influence the healing of tendon, ligament, muscle, and bone. This article examines the basic science of PRP, and it describes the current clinical applications in sports medicine. This study reviews and evaluates the human studies that have been published in the orthopaedic surgery and sports medicine literature. The use of PRP in amateur and professional sports is reviewed, and the regulation of PRP by antidoping agencies is discussed.

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    • "But yet, the effect of PRP treatment in severe knee OA is not well known. Platelets are rich of platelet growth factors, cytokines, chemokines and other mediators (Foster, 2009; Sanchez, 2003; Mishra, 2009; Anitua, 2004; Senet, 2003; Woodell-May, 2011). In vitro and in vivo animal studies have showed the potential impact of PRP on cellular anabolism and tissue regeneration (Kon, 2011; Torricelli, 2011). "
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    ABSTRACT: Although evidence is insufficient, due to being an autologous application with low risk, low cost and potential contribution to the improvement, PRP is emerging as a method to be investigated more. In this study, we aimed to assess the effectiveness of intra-articular platelet-rich plasma injection in knee osteoarthritis by comparing with physical therapy. Seventy patients were included in this study. Patients were randomized into 2 groups; platelet rich plasma (n = 35) and physical therapy (n = 35). Staging of the knee osteoarthritis was made according to the Kellgren-Lawrence classification. At the beginning of treatment (first evaluation step), at the end of treatment (second evaluation step) and 3 months after the end of treatment (third evaluation step) range of motion, VAS pain, WOMAC, SF-36 and Beck depression inventory were investigated. There were no difference between the groups according to demographic data. At the end of the treatment and 3 months after the end of the treatment, significant improvement in range of motion has been detected in both groups, pain was reduced significantly in both groups and when WOMAC scores were compared, improvement was observed in both groups. However, in comparison, at the second and third evaluation steps, improvement at the WOMAC scores of platelet rich plasma group was significantly better than the physical therapy group. When we compare with physical therapy, platelet-rich plasma is seem to be a well tolerated application that shows encouraging clinical results in patients with knee osteoarthritis.
    • "However, other bioactive factors, which include adhesive proteins, clotting and fibrinolytic factors and their inhibitors, proteases and antiproteases, antimicrobial proteins, and membrane glycoproteins, are getting increased attention in the last decade [153]. Another aspect is that í µí»¼-granules also contain monocytes mediators and different interleukins (ILs) and chemokines, such as IL- 1 í µí»½, IL-8, and MIP-1-2-3, regulated on activation, normal T cells expressed and secreted (CCL5), and more others, which are capable of mediating inflammation, stimulate cells chemotaxis, proliferation, and maturation [153] [156] [157]. Although PLTs have now been shown to store and release such a wide range of biologically active proteins, different enigmas, regarding their contents and possible activities on tissue healing, still remain to be solved. "
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    ABSTRACT: Despite its pervasive use, the clinical efficacy of platelet-rich plasma (PRP) therapy and the different mechanisms of action have yet to be established. This overview of the literature is focused on the role of PRP in bone, tendon, cartilage, and ligament tissue regeneration considering basic science literature deriving from in vitro and in vivo studies. Although this work provides evidence that numerous preclinical studies published within the last 10 years showed promising results concerning the application of PRP, many key questions remain unanswered and controversial results have arisen. Additional preclinical studies are needed to define the dosing, timing, and frequency of PRP injections, different techniques for delivery and location of delivery, optimal physiologic conditions for injections, and the concomitant use of recombinant proteins, cytokines, additional growth factors, biological scaffolds, and stems cells to develop optimal treatment protocols that can effectively treat various musculoskeletal conditions.
    05/2015; 2015:1-24. DOI:10.1155/2015/846045
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    • "Furthermore, recurrences are not uncommon and antiinflammatory drugs have well-documented adverse effects. Given the limited effectiveness of standard treatments and the pathophysiological factors involved in tendinopathy, the introduction of injectable platelet concentrates, known as platelet-rich plasma (PRP), holds considerable theoretical appeal as a means of combating some of the mechanisms responsible for the development or persistence of the tendon lesions [6] [7] [8]. The objective of the systematic literature review reported here is to provide an overview of recent data on PRP therapy for tendinopathy, in order to better delineate the potential benefits from adding this intervention to the fairly limited pharmacological armamentarium, as an adjunct to physical and/or surgical treatments. "
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    ABSTRACT: Although tendinopathies constitute a heterogeneous group of conditions, they are often treated by similar combinations of local and systemic symptomatic interventions. The vast number of causes, pathophysiological mechanisms, and histological changes that characterizes tendinopathies may explain that the standard treatment fails in some patients. Platelet-rich plasma (PRP), which contains a host of soluble mediators including growth factors, has been suggested as a second-line treatment for refractory tendinopathy, with the goal of expediting tendon healing or remodeling. Here, we report a systematic literature review of basic research data from humans and animals that support the clinical use of PRP in tendinopathies and of clinical studies in the most common tendinopathies (elbow, knee, shoulder, and Achilles tendon). Our objective is to clarify the role for this new injectable treatment, which is garnering increasing attention. The level of evidence remains low, as few well-designed randomized controlled trials have been published. The available scientific evidence does not warrant the use of PRP for the first-line treatment of tendinopathy. PRP therapy may deserve consideration in specific tendinopathy subtypes, after failure of ultrasound-guided corticosteroid injections. Nevertheless, further studies are needed to define these potential indications and the optimal treatment protocols. A key point is that the complexity of the tendon healing process cannot be replicated simply by injecting a subset of growth factors, whose effects may occur in opposite directions over time. Topics not discussed in this review are the regulatory framework for PRP therapy, PRP nomenclature, and precautions for use, which are described in a previous article (Does platelet-rich plasma have a role in the treatment of osteoarthritis, Ornetti P, et al. [1]). Copyright © 2015 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.
    Joint, bone, spine: revue du rhumatisme 04/2015; 82(4). DOI:10.1016/j.jbspin.2015.02.004 · 2.90 Impact Factor
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