Platelet-rich Plasma: Current Concepts and Application in Sports Medicine
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.
Available from: Malgorzata Pihut
- "Platelet-rich plasma injection is used with increasing frequency in reconstructive orthopedic procedures (tennis elbow, knee injuries, healing of meniscus, cruciate ligaments, Achilles tendons), muscle injuries, dental surgeries and implantations.                          . As highlighted by K. Middleton et al., PRP injections promote optimization of healing environment and facilitate earlier functional rehabilitation of joints . "
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The objective of this study was to evaluate the regression of temporomandibular pain as a result of intra-articular injections of platelet-rich plasma (PRP) to patients with temporomandibular joint dysfunction previously subjected to prosthetic treatment.
Materials and methods:
The baseline study material consisted of 10 patients, both males and females, aged 28 to 53 years, previously treated due to painful temporomandibular joint dysfunction using occlusal splints. All patients were carried out to a specialist functional assessment of the dysfunction using the Polish version of the RDC/TMD questionnaire axis I and II. Intra-articular injections were preceded by a preparation of PRP. The injection sites were determined by the method used during arthroscopic surgical procedures. Following aspiration, 0.5 mL of plasma was injected into each temporomandibular joint.
The comparison of the intensity of pain during all examinations suggests a beneficial effect of the procedure being performed as the mean VAS score was 6.5 at examination I, 2.8 at examination II, and 0.6 at examination III.
Application of the intra-articular injections of platelet-rich plasma into the temporomandibular joints has a positive impact on the reduction of the intensity of pain experienced by patients treated for temporomandibular joint dysfunction.
Available from: Steven D. Zumbrun
- "The use of activated, concentrated platelets, also known as platelet-rich plasma (PRP), in orthopaedic therapies is well studied. Current indications include treatment of medial and lateral epicondylitis, tendinopathies, muscle injuries, joint osteoarthritis, as well as for use intraoperatively with total joint arthroplasty to decrease blood loss and narcotic requirements [1,2]. This therapy is a simple tool that presumably harnesses the body's natural healing pathways to promote faster repair of injured tissue. "
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ABSTRACT: The use of autologous blood concentrates, such as activated, concentrated platelets, in orthopaedic clinical applications has had mixed results. Research on this topic has focused on growth factors and cytokines, with little directed towards matrix metalloproteinases (MMPs) which are involved in post-wound tissue remodeling.
In this study, the authors measured the levels of MMP-2, MMP-9 and a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13 (ADAMTS13), in activated platelets derived from blood of healthy, male volunteers (n = 92), 19 to 60 years old. The levels of the natural inhibitors of these proteases, tissue inhibitor of metalloproteinase 1 (TIMP-1), TIMP-2 and TIMP-4 were also assessed.
Notably, there was no significant change in concentration with age in four of six targets tested. However, TIMP-2 and TIMP-4 demonstrated a statistically significant increase in concentration for subjects older than 30 years of age compared to those 30 years and younger (P = 0.04 and P = 0.04, respectively).
TIMP-2 and TIMP-4 are global inhibitors of MMPs, including MMP-2 (Gelatinase A). MMP-2 targets native collagens, gelatin and elastin to remodel the extracellular matrix during wound healing. A decreased availability of pharmacologically active MMP-2 may diminish the effectiveness of the use of activated, concentrated platelets from older patients, and may also contribute to longer healing times in this population.
Available from: Walter Brehm
- "Diese werden auf Grund ihrer proinflammatorischen Aktivität als nachteilig für die Wundheilung angesehen (Dohan Ehrenfest et al. 2009, Sundman et al. 2011, DeLong et al. 2012). Andererseits existieren Studien, in denen leukozytenreiche ATK zu sehr zufriedenstellenden klinischen Ergebnissen geführt haben (Hall et al. 2009, Lopez- Vidriero et al. 2010, Pedzisz et al. 2010, Dragoo et al. 2012). Es wird angenommen, dass nicht nur die Gesamtzahl der Leukozyten, sondern auch die Verteilung derer Subpopulationen einen Einfluss auf den Effekt von ATK hat (DeLong et al. 2012, Yoshida und Murray 2012). "
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ABSTRACT: Autologous Conditioned Plasma® (ACP) is commonly used to treat orthopedic disorders in horses and is characterized by a moderate supra-physiological platelet concentration, which might however be too low to achieve optimal tissue regenerative effect. Because of considerably lower costs and potentially higher platelet concentrations, non-commercial, manual, double-centrifugation tube methods (mPRP) are often employed instead. However, mPRP preparation is tedious and not standardized. In order to determine if an "in-house" mPRP technique can be a valuable alternative to ACP in the practice, the aim of this study was to compare the manual product to the commercial method with respect to their preparation process, platelet activation level (assessed by measuring the mean platelet volume (MPV) and mean platelet component (MPC)), as well as absolute platelet, leukocyte, transforming growth factor-β1 (TGF-β1) and platelet derived growth factor-BB (PDGF-BB) concentrations. For this purpose, all these parameters were determined in ACP, mPRP and its platelet poor plasma (mPPP) obtained from venous blood samples of 10 healthy adult horses. The mean platelet concentration in mPRP reached 221.4 ± 60.3 × 109/1 and was 1.2- and 1.4-fold higher than in ACP and mPPP respectively. Mean leukocyte content in mPRP reached 25.8 ± 10.9 × 109/1 and was 32.3- and 19.9-fold higher than in ACP and mPPP respectively. Mean PDGF-BB level in mPRP (1.81 ± 0.58 ng/ml) was 1.7-fold higher than both in ACP and mPPR mPRP showed a 2- and 1.8-fold higher mean TGF-β1 concentration (3.62 ± 1.16 ng/ml) than ACP and mPPP respectively. MPC reached 20.3 ± 1.3 g/l in mPRP, 20.6 ± 1.6 g/l in ACP and 20.4 ± 1.7 g/l in mPPR MPV was 8.6 ± 0.7fl in mPRP, 8.7 ± 1.0 fl in ACP and 8.4 ± 0.9fl in mPPP ACP preparation was easily performed, whereas mPRP processing was laborious and time-consuming. Compared to ACP the "in house" mPRP method achieved a slightly higher mean platelet concentration in a much smaller end-volume, though. Mean leukocyte, TGF-β1 and PDGF-BB levels in mPRP were significantly above the values in ACP and mPPP, which both showed similar results. The high mean leukocyte concentration in mPRP could possibly induce unwanted local inflammatory reactions. Platelet activation degree did not differ between the three products. The mPRP processing method described in this study should therefore first be adjusted and optimized before being recommended for extensive use in horses. Compared to other equine platelet concentrates reported in the literature, mPRP and ACP both showed low absolute platelet and GF levels; further comparative clinical studies are needed to determine if these values were sufficient to induce a satisfactory clinical effect.
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