Platelet-rich Plasma: Current Concepts and Application in Sports Medicine

ArticleinThe Journal of the American Academy of Orthopaedic Surgeons 17(10):602-8 · October 2009with52 Reads
Impact Factor: 2.53 · DOI: 10.5435/00124635-200910000-00002 · Source: PubMed
Abstract

Platelet-rich plasma is defined as autologous blood with a concentration of platelets above baseline values. Platelet-rich plasma has been used in maxillofacial and plastic surgery since the 1990s; its use in sports medicine is growing given its potential to enhance muscle and tendon healing. In vitro studies suggest that growth factors released by platelets recruit reparative cells and may augment soft-tissue repair. Although minimal clinical evidence is currently available, the use of platelet-rich plasma has increased, given its safety as well as the availability of new devices for outpatient preparation and delivery. Its use in surgery to augment rotator cuff and Achilles tendon repair has also been reported. As the marketing of platelet-rich plasma increases, orthopaedic surgeons must be informed regarding the available preparation devices and their differences. Many controlled clinical trials are under way, but clinical use should be approached cautiously until high-level clinical evidence supporting platelet-rich plasma efficacy is available.

    • "6 In the Group 3, after mfx, the defect was covered by the periosteum, and then, ACP was applied subperiosteally and intraarticularly. The tissue surface was mostly regular (arrows), with a hyaline matrix mixed with fibrocartilage in some areas but with chondrocytes more organized (asterisks) (H&E) proteoglycans and collagen with the repair tissue generated after PRP treatment, demonstrating similar histological and biomechanical characteristics to normal hyaline cartilage1516171819202122232425262728 32] . Milano et al. performed experimental studies on the effect of autologous PRP with microfracture on chondral defects in a sheep model and reported that treatment with PRP revealed an improvement of cartilage stiffness and showed higher ICRS scores [22, 23]. "
    [Show abstract] [Hide abstract] ABSTRACT: The aim of the present study was to evaluate the effect of microfracture and intraarticular autologous conditioned plasma (ACP) injection on cartilage regeneration in a focal full-thickness chondral defect model created in the knee joint. Full-thickness chondral defects of 3 × 6 mm(2) were surgically created in right medial femoral condyles (MFC) of New Zealand rabbits, and the rabbits were then divided into three groups according to treatment: Group 1 received only microfracture (mfx), Group 2 received mfx plus intraarticular ACP, and Group 3 received mfx; the defect was covered by the periosteum, and then, ACP was applied subperiosteally and intraarticularly. Twelve weeks after injection, the animals were sacrificed and the femoral condyles were evaluated macroscopically and histologically by hematoxylin-eosin staining. Then, histological sections were scored using the International Cartilage Repair Society (ICRS) visual histological scale. Findings showed that in both mfx/ACP-treated groups, the defects were filled regularly and smoothly, the defects had a greater fill and good integration into the surrounding host tissue, and the repair matrix had more hyaline-like character. On the other hand, defects were filled with an irregular, fibrous cartilage in the mfx-treated group. Histological scores in Group 2 and Group 3 were better compared to Group 1. In the present study, we were able to demonstrate a beneficial effect of intraarticular administration of ACP as a coadjuvant of microfractures in order to regenerate hyaline-like cartilage in full-thickness chondral lesions in a rabbit model.
    Full-text · Article · Jul 2015 · Journal of Orthopaedic Surgery and Research
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    • "These nonegrowth factors affect aspects of wound healing such as inflammation proliferation and remodeling [17]. The platelets in PRP can be delivered in a clot that contains adhesion molecules such as fibronectin, fibrin, and vitronectin [18]. MSCs Bone marrow MSCs can be isolated and expanded in culture [19,20]. "
    [Show abstract] [Hide abstract] ABSTRACT: In orthopedic surgery there has been a never-ending quest to improve surgical outcome and the patient's experience. Progression has been marked by the refinement of surgical techniques and instruments and later by enhanced diagnostic imaging capability, specifically magnetic resonance. Over time implant optimization was achieved, along with the development of innovative minimally invasive arthroscopic technical skills to leverage new versions of classic procedures and implants to improve short-term patient morbidity and initial, mid-term, and long-term patient outcomes. The use of regenerative and/or biological adjuncts to aid the healing process has followed in the drive for continual improvement, and major breakthroughs in basic science have significantly unraveled the mechanisms of key healing and regenerative pathways. A wide spectrum of primary and complementary regenerative treatments is becoming increasingly available, including blood-derived preparations, growth factors, bone marrow preparations, and stem cells. This is a new era in the application of biologically active material, and it is transforming clinical practice by providing effective supportive treatments either at the time of the index procedure or during the postoperative period. Regenerative treatments are currently in active use to enhance many areas of orthopedic surgery in an attempt to improve success and outcome. In this review we provide a comprehensive overview of the peer-reviewed evidence-based literature, highlighting the clinical outcomes in humans both with preclinical data and human clinical trials involving regenerative preparations within the areas of rotator cuff, meniscus, ligament, and articular cartilage surgical repair. Copyright © 2015 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
    Full-text · Article · Apr 2015 · PM&R
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    • "Platelet-rich plasma (PRP) is a product widely used in sports medicine, tissue repair, and general surgery. A recent meta-analysis showed this product to be beneficial when introduced into a wound area, be it intra-articular [1] (i.e., joint) injection or direct introduction onto the wound surface234. Creaney and Hamilton have summarized the manner in which both platelets and plasma play an instrumental role in normal healing response [5]. "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Platelet-rich plasma (PRP) is a product widely used in sports medicine, tissue repair, and general surgery. A recent meta-analysis showed this product to be beneficial when introduced into a wound area, be it intra-articular (i.e., joint-injections) or direct introduction onto the wound surface. Methods: Between the years of 2012 and 2014 a questionnaire evaluating surgical outcome after port (venous access device) removal was answered by 100 patients in the control group and 20 patients in a PRP group, leading to a total of 120 patients in this single center, retrospective, subjective outcome evaluation. Results: No statistical difference was shown in postsurgical complication rates, postsurgical pain, decreased mobility, and overall quality of life. A significant difference was shown in overall patient satisfaction and the desire to further improve port area scarring. Results differed significantly in favor of the PRP group. Interestingly, approximately 40.2% of patients are dissatisfied with the surgical outcome after port removal in the control group. This result, though surprising, may be improved to 10% dissatisfaction when a PRP product is used. Conclusion: PRP products such as Arthrex ACP are safe to use and present an additional option in improving surgical outcome.
    Full-text · Article · Apr 2015
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