Abstract
Chronic complex musculoskeletal injuries that are slow to heal pose challenges to physicians and researchers alike. Orthobiologics is a relatively newer science that involves application of naturally found materials from biological sources (for example, cell-based therapies), and offers exciting new possibilities to promote and accelerate bone and soft tissue healing. Platelet-rich plasma (PRP) is an orthobiologic that has recently gained popularity as an adjuvant treatment for musculoskeletal injuries. It is a volume of fractionated plasma from the patient's own blood that contains platelet concentrate. The platelets contain alpha granules that are rich in several growth factors, such as platelet-derived growth factor, transforming growth factor-β, insulin-like growth factor, vascular endothelial growth factor and epidermal growth factor, which play key roles in tissue repair mechanisms. PRP has found application in diverse surgical fields to enhance bone and soft-tissue healing by placing supra-physiological concentrations of autologous platelets at the site of tissue damage. The relative ease of preparation, applicability in the clinical setting, favorable safety profile and possible beneficial outcome make PRP a promising therapeutic approach for future regenerative treatments. However, there is a large knowledge gap in our understanding of PRPs mechanism of action, which has raised skepticism regarding its potential efficacy and use. Thus, the aim of this review is to describe the various factors proposed to contribute to the biological activity of PRP, and the published pre-clinical and clinical evidence to support it. Additionally, we describe the current techniques and technology for PRP preparation, and review the present shortcomings of this therapy that will need to be overcome if it is to gain broad acceptance.
Highlights
Platelet-rich plasma (PRP) is defined as a portion of the plasma fraction of autologous blood having a platelet concentration above baseline [1]
The ideology behind PRP treatment is the reversal of the red blood cell:platelet ratio by decreasing red blood cells to 5% and more importantly concentrating platelets containing a powerful concoction of growth factors to 94%
The cross-sectional area of the preparation rich in growth factors (PRGF)-treated tendons increased less, and transforming growth factor (TGF)-β1, Platelet-derived growth factor a and b (PDGF)-αβ, Vascular endothelial growth factor (VEGF), Epidermal growth factor (EGF) and hepatocyte growth factor (HGF) significantly correlated with the number of platelets, suggesting that operative management of tendons combined with the application of autologous PRGF promoted enhanced healing and functional recovery
Summary
Platelet-rich plasma (PRP) is defined as a portion of the plasma fraction of autologous blood having a platelet concentration above baseline [1]. An in vitro study suggested that administering autologous platelet-rich clots might be beneficial in the treatment of tendon injuries by inducing cell proliferation and promoting the synthesis of angiogenic factors during the healing process [41]. Human clinical studies - applications in different pathological conditions The use of platelet rich plasma is still a relatively new treatment for orthopedic patients, physicians are increasingly using PRP as an alternative to medication and surgery. Only intramuscular PRP injections were prohibited, whereas all other routes of administration, such as intra-articular or intra- or peri-tendinous, were permitted and only required a declaration of use This restriction was due to the concern of the WADA List Expert Group that growth factors contained in PRP may stimulate muscle satellite cells and increase muscle size and strength beyond normal healing. WADA continues to review PRP usage in the light of new scientific information as it becomes available
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