A New Innovative Therapy for Sports Related Soft Tissue Injuries: Platelet-Rich Plasma (PRP)

Abstract

Introduction: Platelet-rich plasma (PRP) is the cellular component of plasma that settles after centrifugation, and contains numerous growth factors. There is increasing interest in the sports medicine about providing endogenous growth factors directly to the injury site, using autologous blood products such as PRP, to potentially facilitate healing and earlier return to. Despite this interest, and apparent widespread use, there is a lack of high-level evidence trials assessing the efficacy of PRP. Systematic review: We performed a systematic review of the literature and included clinical studies on PRP injections for ligament, muscle or tendon injuries. A few randomized controlled clinical trials have assessed the efficacy of PRP injections and none have demonstrated scientific evidence of efficacy. Scientific studies should be performed to assess clinical indications, efficacy, and safety of PRP, and this will require appropriately powered randomized controlled trials with adequate and validated clinical and functional outcome measures and sound statistical analysis. Original research: Our group recently studied the effects of a platelet-rich plasma injection in patients with chronic midportion Achilles tendinopathy at 1-year follow-up in a randomized controlled trial; Fifty-four patients, aged 18 to 70 years, with chronic tendinopathy were randomized to receive either a blinded injection containing platelet-rich plasma or saline (placebo group) in addition to an eccentric training program. The validated mean Victorian Institute of Sports Assessment-Achilles score improved in both the platelet-rich plasma group and the placebo group after 1 year. There was no significant difference in increase between both groups (adjusted between-group difference, 5.5; 95% confidence interval, −4.9 to 15.8, P = .292). This randomized controlled trial showed no clinical and ultrasonographic superiority of platelet-rich plasma injection over a placebo injection. Overall conclusion: Based on the systematic review and original research, the potential risks involved with PRP are fortunately very low. PRP got the potentiality to facilitate healing and earlier return to sport after musculoskeletal injury, but benefits remain unproven to date and there is a need for high quality studies with a randomized design. Aspetar is currently performing a level I evidence research project into the benefits of PRP in muscle injuries.