Abstract
The convincing background of the recent studies, investigating the different potentials of platelet-rich plasma, offers the clinician an appealing alternative for the treatment of cartilage lesions and osteoarthritis. Recent evidences in literature have shown that PRP may be helpful both as an adjuvant for surgical treatment of cartilage defects and as a therapeutic tool by intra-articular injection in patients affected by osteoarthritis. In this review, the authors introduce the trophic and anti-inflammatory properties of PRP and the different products of the available platelet concentrates. Then, in a complex scenario made of a great number of clinical variables, they resume the current literature on the PRP applications in cartilage surgery as well as the use of intra-articular PRP injections for the conservative treatment of cartilage degenerative lesions and osteoarthritis in humans, available as both case series and comparative studies. The result of this review confirms the fascinating biological role of PRP, although many aspects yet remain to be clarified and the use of PRP in a clinical setting has to be considered still exploratory.
Highlights
Platelets are one of the smallest structures among the circulating cells in blood; they are anucleate, unable to replicate, their diameter is between 2 and 4 μm, and they consist of cytoplasm and vesicles and survive no more than 10 days in circulation [1].Yet, they are in continual “call of duty” because inside them lies one of the most powerful reservoirs of factors responsible for tissue repair
Better results were found in smaller lesions and in patients without previous surgery. They confirmed the stability of their clinical results at 4 years of follow-up, a slight decline in the AOFAS scores was observed between 24 and 48 months postoperatively [64]. The authors compared this technique with previously performed cartilage repair procedures by means of open field autologous chondrocyte implantation (ACI), using a periosteal flap as a sealing for the cells, and arthroscopic ACI, in which the same esterified hyaluronic acid-derivative membrane was used as a scaffold [63]
This comparative retrospective study showed a intriguing result: similar pattern of AOFAS improvement was observed for the three groups at the end of the followup (36 months) as well as comparable histological and magnetic resonance imaging (MRI) findings. This suggests that the single-stage association of bone marrow concentrate and the PRP may be as effective as other regenerative techniques like the ACI for the treatment of talar osteochondral lesions, with lower costs and less invasivity for the patients
Summary
Platelets are one of the smallest structures among the circulating cells in blood; they are anucleate, unable to replicate, their diameter is between 2 and 4 μm, and they consist of cytoplasm and vesicles and survive no more than 10 days in circulation [1]. (v) the possible use of homologous PRP produced by a blood bank; this alternative would reduce the bias derived from the interindividual platelet differences and would offer a single homogeneous and reproducible product available for clinical use, to the blood transfusion concept; this method has been adopted in different clinical settings, in example for the cure of necrobiosis lipoidica in diabetic patients with good results [40]; recently, the use of allogenous PRP has been proposed in literature for the treatment of cartilage defects in humans; allogenous PRP was used as a carrier for autologous culture expanded bone marrow MSC in the pilot study of Haleem et al [41]; it may represent a potential opportunity in the field of PRP application for cartilage repair. Literature indicates that the evidence of a valid effect of PRP for cartilage repair is perceptible both for the treatment of cartilage lesions by means of reconstructive surgery and for the treatment of osteoarthritis by means of conservative intra-articular delivery
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