Platelet rich plasma—Current evidence and use in musculoskeletal medicine

Abstract

The author will present a literature review on current evidence and use of platelet rich plasma (PRP) in musculoskeletal (MSK) medicine. Reports of PRP use was first made in 1987 by Ferrari et al. in open heart surgery. Since then, there has been extensive use in a wide range of medical fields including, orthopaedics, sports medicine, dentistry, ENT, neurosurgery, cosmetic/aesthetic medicine, wound healing, cardiothoracic and maxillofacial surgery. Much of the evidence on the use in musculoskeletal (MSK) medicine has been in animal studies, anecdotal or case series. It is only in recent years that randomized controlled trials in PRP use have been published. Whilst much of the research and use of PRP in MSK medicine has been in treating tendon pathologies (particularly chronic tendinopathies), PRP is also used in bone, joint, muscle and ligament injuries. This has included augmentation for acute orthopaedic procedures such as joint replacement, internal fixation of fractures (particularly for non unions), arthrodesis and tendon repairs. These uses and any evidence will be presented by the author. It is generally accepted that growth factors play a central role in tissue healing and regeneration. In blood, platelets have a role in clotting, but also contain alpha granules which contain various growth factors including TGF-beta, PDGF (platelet derived growth factor), EGF (endothelial growth factor), VEGF (vascular endothelial growth factor), FGF (fibroblast growth factor) and IGF (insulin growth factor). It is understood that these growth factors perform a variety of tasks including regulation of cellular migration and proliferation, stimulation of cell replication, stimulation of angiogenesis, and acceleration of mesenchymal stem cell replication and osteoid production. The author was an invited presenter at a landmark invitation only international seminar on use of growth factors in sports medicine held in Qatar in February 2009 where the medical directors of both IOC and WADA were present. At this seminar, a randomized controlled trial on use of PRP in hamstring muscle tears was designed, targeted at the national football competition, which were a captive audience. Following this, WADA released its 2010 guidelines which included recommendations specifically on PRP, allowing use in MSK conditions apart fro into muscle. The 2011 WADA guidelines now allow the use of PRP for all MSK areas.