IOC consensus paper on the use of platelet-rich plasma in sports medicine : editor's choice

Abstract

Acute and chronic musculoskeletal injuries in sports are common and problematic for both athletes and clinicians. A significant proportion of these injuries remain difficult to treat, and many athletes suffer from decreased performance and longstanding pain and discomfort.1 In 2008, the International Olympic Committee (IOC) published a consensus document on the importance of molecular mechanisms in connective tissue and skeletal muscle injury and healing.2 This document predicted an increase in the use of autologous growth factors, as it has indeed happened following that publication. Platelet-rich plasma (PRP) (also referred to as platelet-rich in growth factors, platelet-rich fibrin matrix, platelet-rich fibrin, fibrin sealant, platelet concentrate) is now being widely used to treat musculoskeletal injuries in sports and draws widespread media attention despite the absence of robust clinical studies to support its use.3 Of the few studies on the effectiveness of PRP in clinical settings published, very few are of sufficient methodological quality that would enable evidence-based decision-making. PRP and its variant forms were originally used in clinical practice as an adjunct to surgery to assist in the healing of various tissues. PRP has also been used in prosthetic surgery to promote tissue healing and implant integration, and to control blood loss.4 5 Furthermore, the application of activated PRP has an effect on pain and pain medication use following open subacromial decompression surgery.5 Initially, PRP was mainly used in oral surgery.6 7 Subsequently, PRP has also been used at the time of surgery involving shoulder,8 hip9 and knee joint procedures,10 11 including anterior cruciate ligament (ACL) reconstruction,12 and it has been used to improve bone healing. 13 More recently, PRP in an injectable form has been used for the management of common muscle,14 tendon15 and cartilage injuries.16 As predicted by the 2008 IOC consensus document on the molecular mechanisms in connective tissue and skeletal muscle injury and healing,2 there is significant anecdotal evidence that the use of PRP for treating musculoskeletal injuries has increased in recent times. Currently, PRP is not considered as a drug or a therapeutic substance, and so it does not have the usual regulatory requirements that would generally be needed for a substance used in regular clinical practice.