Abstract
In recent years biological strategies are being more widely used to treat cartilage lesions. One of the most exploited novel treatments is Platelet-rich Plasma (PRP), whose high content of growth factors is supposed to determine a regenerative stimulus to cartilaginous tissue. Despite many promising in vitro and in vivo studies, when discussing clinical application a clear indication for the use of PRP cannot be assessed. There are initial encouraging clinical data, but only a few randomized controlled trials have been published, so it is not possible to fully endorse this kind of approach for the treatment of cartilage pathology. Furthermore, study comparison is very difficult due to the great variability in PRP preparation methods, cell content and concentration, storage modalities, activation methods and even application protocols. These factors partially explain the lack of high quality controlled trials up to now. This paper discusses the main aspects concerning the basic biology of PRP, the principal sources of variability, and summarizes the available literature on PRP use, both in surgical and conservative treatments. Based on current evidence, PRP treatment should only be indicated for low-grade cartilage degeneration and in case of failure of more traditional conservative approaches.
Highlights
Recent years have seen the flourishing of a completely new approach for the treatment of cartilage lesions
Platelet-derived growth factors (GFs) contained in Platelet-rich Plasma (PRP) are the most exploited way to administer a biological stimulus to several different damaged tissues, such as cartilage, tendons and muscle that might benefit from this particular approach [4]
A lot has still to be understood about PRP for the treatment of cartilage lesions
Summary
Recent years have seen the flourishing of a completely new approach for the treatment of cartilage lesions. Storage procedures are a hot topic: freezethawing is one method but it is thought to impair platelet function and lifespan, and alter the GFs’ release pattern in a negative way, besides favoring the accumulation of pyrogenic cytokines and increasing the risk of bacterial proliferation For these reasons some authors prefer fresh administration of PRP immediately after its preparation ( requiring blood harvesting for each injection, in case of multiple treatments) [16]. In the light of all the issues considered, there follows a summary of the factors playing key roles in study comparison [14]: PRP preparation method; PRP formulation and cellular content, including concentration rates and cell counts; 122 The Open Orthopaedics Journal, 2013, Volume 7. The lack of commonly accepted guidelines and the variety of biological and procedural differences partially explain the limits of the available literature and justify the need to perform high quality trials to clarify the high number of still open questions [20]
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