Administration Of Platelet-rich Plasma Research Articles

Platelet-rich plasma for androgenetic alopecia: A review of the literature and proposed treatment protocol.

Androgenetic alopecia (AGA) is a common hair loss disorder caused by genetic and hormonal factors that are characterized by androgen-related progressive thinning of scalp hair in a defined pattern. By the age of 60 years, 45% of men and 35% of women develop AGA. Currently, U.S. Food and Drug Administration-approved treatments for AGA include oral finasteride and topical minoxidil. Due to the limited number of effective therapies for AGA, platelet-rich plasma (PRP) has become an effective alternative treatment. PRP is an autologous concentration of platelets in plasma with numerous growth factors that contribute to hair regeneration. The growth factors contained within the alpha granules of platelets act on stem cells in the bulge area of the hair follicles and stimulate the development of new follicles along with neovascularization. PRP has become a promising treatment modality for AGA. Although there have been several studies previously reported, a standard practice for PRP preparation and administration as well as a method to evaluate results have not been established. This literature review was conducted to evaluate the effectiveness of PRP for AGA and discuss the various treatment protocols that have been proposed.

Platelet-rich plasma and the shoulder: clinical indications and outcomes.

The orthopedic community has seen a rapid rise in the clinical use of platelet-rich plasma (PRP) in the management of shoulder pathologies over the past decade. The purpose of this paper is to review the current literature regarding the indications and outcomes of PRP for the surgical and non-surgical management of common shoulder pathologies, including rotator cuff tears. Multiple studies have been published recently regarding the use of PRP for the operative and non-operative treatment of rotator cuff tears. There has been less research published on the use of PRP in the management of other conditions of the shoulder. Despite attempts to standardize and classify PRP formulations, there remains great variation in the inter- and intra-subjection composition, preparation, and administration techniques of PRP, limiting the conclusions that can be drawn regarding the utility and effectiveness of this biologic treatment as reported by Mazzocca et al. (J Bone Joint Surg Am. 94(4):308-16, 2012). Recent literature has shown equivocal to minor benefit of PRP use for shoulder pain, function, and healing. While few complications have been reported and PRP administration appears to carry little risk to the patient, the body of literature is currently inconclusive regarding the clinical benefit and cost-effectiveness of PRP in the treatment of shoulder pathology. As for PRP use specifically as an adjunct to surgical rotator cuff repairs, there is no clear consensus on its effectiveness in either clinical or structural outcomes. To further delineate the efficacy of PRP for shoulder pathology, it is essential that more double-blinded, randomized controlled investigations with large sample sizes and standardized PRP preparations be performed.

Current Treatment Options for Osteoarthritis

Osteoarthritis (OA) is the most common joint disease and a leading cause for impaired function and disability with significant treatment costs and socio-economic burden. Despite recent achievements in the knowledge on disease pathogenesis, the treatment is still a challenge and contrary to the inflammatory joint diseases, no disease-modifying drugs are currently available for OA. Different response in different localizations of the disease further complicates the therapeutic choice. The standard pharmacological treatment includes agents for control of pain and inflammation (non-steroidal anti-inflammatory drugs, analgesics including opioids, intraarticular corticosteroids) and the group of the symptomatic slow acting drugs for OA such as glucosamine sulfate, chondroitin sulfate, diacerein, unsaponifiables extract of soybean and avocado administered orally and intrarticular hyaluronic acid. In addition, a number of studies investigate the efficacy of classic disease-modifying drugs used in inflammatory arthritides and antiresoptive agents as potential future therapies that could prevent structural progression of the disease. In a number of small studies, therapeutic efficacy of hydroxychloroquine (HCT) in OA has been suggested, but the results are contradictory. The first results from a multicenter, randomized, double-blind, placebo-controlled trial focused on symptomatic hand OA were recently reported (British HERO study). It has been concluded that HCQ was not superior than placebo as analgesic treatment or for reduction of the radiographic progression in hand OA. Placebo-controlled trial evaluating the efficacy of HCT in inflammatory and erosive hand OA is under way (OA TREAT study). Another field of recent research is the efficacy of TNF-alpha blockers based on the knowledge of their high efficacy in the inflammatory joint diseases and the significant role of TNF-alpha in the pathogenesis of OA. However, current evidence from the available studies does not support the use of TNF-alpha blockers in OA. The benefit of TNF-alpha blockers in specific sub-groups of patients with higher level of inflammation, objective criteria for the expected responders as well as cost-effectiveness of such treatment is a matter of further research and discussion. New biologic agents that target the nerve growth factor-β are other currently investigated drugs as a potential symptomatic therapeutic option in OA. Significant research has been also focused on revealing potential symptomatic or eventually disease-modifying efficacy of drugs that target bone metabolism due to contemporary notion for the crucial role of the subchondral bone in OA pathology and the positive association between the increased subchondral bone turnover and the progressive cartilage loss. A significant delay of joint width narrowing vs. placebo has been observed in patients with symptomatic knee OA after treatment with strontium renelate. The intraarticular administration of platelet-rich plasma is evaluated as potential future therapy and has been tried in knee and hip OA with beneficial effect. Based on the current knowledge about the OA pathogenesis and the undergoing studies, new therapies for OA are awaited both as a safe symptomatic treatment - alternative to the conventional treatment options and as a disease-modifying therapy that would revolutionize the contemporary approach to OA.

Evaluation of the Short-Term Effects of Intra-Articular Administration of Platelet-Rich Plasma in Horses with Experimentally Induced Synovitis

Evaluation of the Short-Term Effects of Intra-Articular Administration of Platelet-Rich Plasma in Horses with Experimentally Induced Synovitis

The effectiveness of platelet-rich plasma on the skin wound healing process: A comparative experimental study in sheep.

Aim:The therapeutic evaluation of the biological effect of platelet-rich plasma (PRP) used as a surgical adjunct to maintain the inflammatory process and to potentiate tissue healing, make the subject of recent research in regenerative medicine. This study was designed to evaluate the healing activity of PRP by its topical application on the skin experimentally injured in a sheep model.Materials and Methods:The study was conducted on 9 adult and clinically healthy males sheep. PRP was obtained by a protocol of double centrifugation of whole blood from each animal. After sterile skin preparation, full-thickness excisional wounds (20 mm x 20 mm) were created on the back of each animal. The animals were randomly divided into three equal groups of three sheep for each. In Group I, the wounds were treated with PRP, in Group II; wounds were treated with Asiaticoside; in Group III, wounds were treated with saline solution. The different treatments were administered topically every 3 days. Morphometric measurements of the contraction surface of the wounds and histopathological biopsies were carried out at the 3rd, 7th, 14th, 21st, and 28th days of healing.Results:The results of the morphometric data obtained revealed that it was significant differences recorded at the 7th and 14th day of healing in favor for animals of Group I. Semi-quantitative histopathological evaluation showed that PRP reduces inflammation during 3 first days post-surgical and promotes epithelialization in 3 weeks of healing.Conclusion:We concluded that topical administration of PRP obtained by double centrifugation protocol could potentially improve the skin healing process in sheep.

Effect of Intraoperative Platelet-Rich Plasma Treatment on Postoperative Donor Site Knee Pain in Patellar Tendon Autograft Anterior Cruciate Ligament Reconstruction: A Double-Blind Randomized Controlled Trial

Background: Donor site morbidity in the form of anterior knee pain is a frequent complication after bone–patellar tendon–bone (BPTB) autograft anterior cruciate ligament (ACL) reconstruction. Hypothesis/Purpose: The purpose was to examine the effect of the intraoperative administration of platelet-rich plasma (PRP) on postoperative kneeling pain. It was hypothesized that PRP treatment would reduce knee pain. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Fifty patients (mean ± SD age, 30 ± 12 years) undergoing BPTB ACL autograft reconstruction were randomized to the PRP (n = 27) or sham (n = 23) treatment. In either case, 10 mL of venous blood was drawn before the induction of anesthesia and either discarded (sham) or processed (PRP) for preparation of a PRP gel to be later mixed with donor site bone chips and inserted into the patellar defect. At 12 weeks, 6 months, 1 year, and 2 years after surgery, patients completed International Knee Documentation Committee (IKDC) forms and visual analog scale pain scores for activities of daily living and kneeling. Healing indices at the donor site were assessed by routine noncontrast magnetic resonance imaging (MRI) at 6 months. Mixed-model analysis of variance was used to assess the effect of PRP on patient symptoms and MRI indices of donor site healing, as measured by the width of the donor site defect. Results: Kneeling pain, pain with activities of daily living, and IKDC scores were not different between treatment groups at any of the time intervals (P = .08-.83). Kneeling pain improved from 12 weeks to 6 months and from 1 to 2 years (P < .05). IKDC scores improved substantially from 12 weeks to 6 months (P < .001) and continued to improve to 2 years (PRP, 86 ± 19; sham, 89 ± 10). MRI indices of donor site healing were not different between treatment groups (P = .53-.90). Conclusion: Whether randomized to receive PRP in their patellar defect or not, patients continued to have similar levels of kneeling pain and patellar defect sizes after autograft BPTB ACL reconstruction. Registration: NCT01765712 (ClinicalTrials.gov identifier).

Efficacy of platelet rich plasma in comparison to steroid for the management of chronic plantar fasciitis

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Chronic plantar fasciitis is often a difficult to treat entity and platelet-rich plasma (PRP) is an upcoming modality instead of steroid in chronic cases of plantar fasciitis resistant to traditional non-operative management.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; Sixty patients with chronic plantar fasciitis were prospectively randomised into 2 groups and treated with either a single injection of 3 cc PRP or 40 mg DepoMedrol (Cortisone) injection and followed for a year. Immediately prior to PRP or cortisone injection American Orthopedic Foot and Ankle Society (AOFAS) hind foot scoring was done for all patients. These scores were repeated at 6 weeks, 6 months and 12 months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Six weeks evaluation of AOFAS after PRP and corticosteroid administration, the mean visual analogue scale (VAS Score) showed a significant increase in corticosteroid group (4.2) as compared to PRP group (5.8). But, the PRP group (1.8) showed significant improvement in mean VAS scores as compared to Steroid group (3.4) after a year of the treatment. Similarly, the AOFAS score improved significantly in the steroid group (64.4) at 6wks as compared to the PRP group (52.2) but at 12 months however, the PRP group sustained its effect with a mean AOFAS score of 92.2 while in the steroid group, the score dropped to a mean of 78.4.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; PRP was more effective than steroid for the long term treatment of chronic plantar fasciitis. Level of Evidence: Level I, prospective randomized comparative series.&lt;/p&gt;

Synergistic activity of platelet rich plasma and high volume image guided injection for patellar tendinopathy.

Platelet rich plasma and high volume image guided injections of saline have been used in the treatment of patellar tendinopathy with positive results. As the different mechanisms of action do not interfere each other, it can be hypothesized that they can be used in combination. Aim of this study was twofold: first, to evaluate the efficacy of these two treatments in the management of patellar tendinopathy; second, to verify whether the combination of these therapies could provide further advantages. Fifty-four patients suffering from patellar tendinopathy were enrolled. After clinical (VAS and VISA-P) and sonographic evaluation, two ultrasound guided injections (2weeks apart) of platelet rich plasma, high-volume image-guided injections of saline, or both in association were performed. The VAS and VISA-P scores obtained from the three treatments groups (18 patients in each group) were compared across the different follow-up times (3 and 6months). In the short term both treatments showed comparable efficacy, whereas in the medium term the positive effects of high-volume image-guided injections gradually diminished and platelet rich plasma showed greater efficacy. Better results (reduced pain, improved function and increased number of subjects who exhibited optimal recovery [> 20 points in VISA-P score]) were observed when both procedures were associated. The contemporaneous administration of platelet rich plasma and high volume image guided injections of saline treatments, which influence tendon repair by means of different mechanisms, grants a greater improvement for patellar tendinopathy. This finding has clinical relevance, given that this condition has a substantial impact on sports and work performance. III.

First data on in vitro fertilization and blastocyst formation after intraovarian injection of calcium gluconate-activated autologous platelet rich plasma

Platelets modulate clinically relevant yet incompletely understood tissue regeneration processes, and platelet rich plasma (PRP) has been previously used with some success in various non-reproductive medical contexts. Here, we extended PRP application to ovarian tissue with a view to document impact on ovarian reserve among women attending for infertility treatment. PRP was freshly isolated from patients (n= 4) with diminished ovarian reserve as determined by at least one prior IVF cycle canceled for poor follicular recruitment response or estimated by serum AMH and/or FSH, no menses for ≥1 year. Immediately following substrate isolation and activation with calcium gluconate, approximately 5 mL of autologous PRP was injected into each ovary under direct transvaginal sonogram guidance. For each study subject, AMH, FSH, and serum estradiol data were recorded at two-week intervals post-PRP and compared to baseline (pre-PRP) values. In this pilot group, mean (±SD) patient age was 42 ± 4 years with infertility duration reported as 60 ± 25 months. Following this protocol of intraovarian PRP administration, increases in serum AMH (p = .17), decreases in FSH (p < .01), or both, were observed in all cases, sufficient to permit retrieval of 5.3 ± 1.3 MII oocytes. IVF occurred 78 ± 22 (range = 59–110) days after activated PRP injection, and results appeared independent of patient age, infertility duration, baseline platelet concentration or pretreatment antral follicle count. Each patient had at least one blastocyst suitable for cryopreservation. While autologous PRP has been successfully applied therapeutically to various tissues to accelerate healing and wound repair, this is the first description of direct injection of activated PRP into the human ovary of poor prognosis IVF patients. Evidence of improved ovarian function was noted in all who received intraovarian PRP, possibly as early as two months after treatment. Additional research is needed to clarify (and enhance) which PRP components are responsible for altered ovarian function, and to identify predictive characteristics for patients most likely to benefit from this intervention.

Intra-articular Injections of Platelet-Rich Plasma Releasate Reduce Pain and Synovial Inflammation in a Mouse Model of Osteoarthritis

Background: Osteoarthritis (OA) is a degenerative joint disease leading to pain and disability for which no curative treatment exists. A promising biological treatment for OA is intra-articular administration of platelet-rich plasma (PRP). PRP injections in OA joints can relieve pain, although the exact working mechanism is unclear. Purpose: To examine the effects of PRP releasate (PRPr) on pain, cartilage damage, and synovial inflammation in a mouse OA model. Study Design: Controlled laboratory study. Methods: OA was induced unilaterally in the knees of male mice (n = 36) by 2 intra-articular injections of collagenase at days –7 and –5. At day 0, pain was measured by registering weight distribution on the hindlimbs, after which mice were randomly divided into 2 groups. Mice received 3 intra-articular injections of PRP or saline in the affected knee. Seven mice per group were euthanized at day 5 for assessment of early synovial inflammation and cartilage damage. Pain in the remaining mice was registered for a total of 3 weeks. These mice were euthanized at day 21 for assessment of cartilage damage and synovial inflammation on histological evaluation. Antibodies against iNOS, CD163, and CD206 were used to identify different subtypes of macrophages in the synovial membrane. Results: Mice in the PRPr group increased the distribution of weight on the affected joint in 2 consecutive weeks after the start of the treatment (P < .05), whereas mice in the saline group did not. At day 21, PRPr-injected knees had a thinner synovial membrane (P < .05) and a trend toward less cartilage damage in the lateral joint compartment (P = .053) than saline-injected knees. OA knees treated with saline showed less anti-inflammatory (CD206+ and CD163+) cells at day 5 than healthy knees, an observation that was not made in the PRPr-treated group. A higher level of pain at day 7 was associated with a thicker synovial membrane at day 21. The presence of CD206+ cells was negatively associated with synovial membrane thickness. Conclusion: In a murine OA model, multiple PRPr injections reduced pain and synovial thickness, possibly through modulation of macrophage subtypes. Clinical Relevance: PRPr injections in early OA or shortly after joint trauma can reduce pain and synovial inflammation and may inhibit OA development in patients.

Combination of platelet rich plasma in fractional carbon dioxide laser treatment increased clinical efficacy of for acne scar by enhancement of collagen production and modulation of laser-induced inflammation.

Platelet-rich plasma (PRP) which contains large amounts of growth factors has been tried to enhance therapeutic efficacy of laser treatment for acne scar with unknown underlying mechanism. The present study was conducted to investigate the molecular mechanism of increased clinical efficacy of PRP when combined with fractional laser treatment for treating acne scars. Subjects with mild to moderate acne scars were treated with two sessions of fractional CO2 laser therapy given with and without co-administration of PRP. Skin biopsy specimens were obtained at baseline, 1, 3, 7, and 28 days for investigation of molecular profiles associated with skin changes produced by laser plus PRP treatment. The PRP treatment increased clinical efficacy with decreased severity of adverse effects such as erythema, swelling and oozing. Productions of TGFβ1 and TGFβ3 proteins were more highly elevated on the PRP-treated side of the face compared to the control side at day 28. Furthermore, PRP-treated side showed significant increase of c-myc, TIMP, and HGF expression. Experimental fibroblast culture model was also used. PRP administration after laser irradiation increased expressions of p-Akt, TGFβ1, TGFβ3, β-catenin, collagen 1, and collagen 3 in both dose-dependent and time dependent manners in fibroblast. Moreover, we acquired clinical and histological data through randomized control clinical trial. Taken together with human study results combined with the data from cell experiments we suggest that PRP treatment increased fibrogenetic molecules induced by fractional CO2 laser, which have association with clinical effect. Lasers Surg. Med. 50:302-310, 2018. © 2017 Wiley Periodicals, Inc.

The effectiveness of platelet-rich plasma in an anosmia-induced mice model.

In this study, we aimed to functionally and morphologically demonstrate the effectiveness of platelet-rich plasma (PRP) on anosmia in a mouse model of anosmia. Animal study. A total of 16 male mice were included. When selecting the mice, the food-finding test (FFT) was used to make sure that the animals could smell, and anosmia was induced by administration of intraperitoneal 3-methylindole. The mice were randomly divided into two groups of eight (groups A and B). After 1 week, topical PRP was administered to the mice in group A and topical saline was administered to the mice in group B. The FFT was again administered at 7, 14, and 21 days. The mice were sacrificed on day 21, the olfactory neuroepithelium was histopathologically examined, and the epithelial damage scores and epithelial thickness were measured. After topical administration of PRP and saline, the difference in the average FFT values of the groups was statistically significant at 7, 14, and 21 days (P < 0,005). During the histopathological examination, the epithelial damage score was statistically significantly lower in the PRP group (P = 0.001) than in the saline group, and epithelial thickness was statistically significantly greater in the PRP group compared to the saline group (P = 0.003). We showed that PRP administration has a curative effect on olfactory functions in an anosmia-induced mice model. However, there is a need for further research before PRP can be considered for use in patients with anosmia in clinical practice. NA. Laryngoscope, 128:E157-E162, 2018.

Use of Platelet-Rich Plasma Immediately After an Injury Did Not Improve Ligament Healing, and Increasing Platelet Concentrations Was Detrimental in an In Vivo Animal Model

Background: Limited information in basic science and clinical trials exists to determine if ligament healing may be accelerated with the use of biological adjuvants, such as platelet-rich plasma (PRP). However, there has been widespread acceptance of PRP for use in clinical practice, despite an inadequate understanding of its biological mechanism of action. Purpose: To determine whether a single dose of PRP could accelerate ligament healing and correspondingly improve histological characteristics and biomechanical properties when injected immediately postoperatively into the injured medial collateral ligament (MCL) of New Zealand White rabbits. Study Design: Controlled laboratory study. Methods: Eighty skeletally mature New Zealand White rabbits (160 knees) were used. The MCL was torn midbody to simulate a grade 3 tear. After an acute injury of the MCL, the administration of autologous PRP at 3 different platelet concentrations (0 million/uL, platelet-poor plasma [PPP]; 0.6 million/uL, 2 times the baseline [2× PRP]; and 1.2 million/uL, 4 times the baseline [4× PRP]) was performed and compared with a saline injection control in the contralateral knee. Histological analysis and a biomechanical endpoint characterization were utilized to assess ligamentous healing and compare it to a sham surgery group. Results: The PPP (P = .001) and 4× PRP (P = .002) groups had a significantly lower collagen subscore than the sham surgery group. No other differences were observed among the treatment groups, including the vascularity subscore and overall ligament tissue maturity index score. Compared with saline-injected contralateral knees, the maximum load for PPP and 2× PRP was not significantly different (P = .788 and .325, respectively). The maximum load and stiffness for knees treated with 4× PRP were significantly less than for the saline-treated contralateral knees (P = .006 and .001, respectively). Conclusion: One single dose of PPP or 2× PRP at the time of injury did not improve ligament healing. In addition, 4× PRP negatively affected ligament strength and histological characteristics at 6 weeks after the injury. Clinical Relevance: The current practice of treating knee ligament injuries with PRP may not improve healing at low doses of PRP. The decreased mechanical properties and histological appearance of the torn MCL suggest that high doses of PRP decrease the quality of repair tissue. Further in vivo studies are necessary to determine the dosing and timing of PRP administration after a ligament injury before the widespread use of PRP to treat ligament injuries is recommended.

Platelet-rich plasma and its effect in bone regeneration in mandibular fractures. Controlled clinical trial

Currently there is great interest in developing clinical applications of platelet-rich plasma to enhance bone repair. To assess bone regeneration in mandibular fractures, with the application of this adjuvant. Twenty patients with mandibular fractures were included in a randomized clinical trial. Patients of the experimental group (n = 10) were submitted to internal fracture reduction and administration of platelet-rich plasma, and patients of the control group (n = 10) were submitted to the same surgical procedure without plasma application. Radiologic assessment was made before and at 1 and 3 months after surgery. X-rays were digitalized for analyze intensity and density as reflection of bone regeneration. The average age was 32 ± 11.3 years and 31.2 ± 8.48 years respectively (p = 0.76). The radiographic intensity and density in the experimental group at the 1st and 3rd month were higher in contrast to the control group (p < 0.005). Bone regeneration time was 3.7 ± 0.48 and 4.5 ± 0.52 weeks respectively (p = 0.002). There was no morbidity related to the application of the platelet-rich plasma. The platelet-rich plasma increased the bone intensity and density in the fracture trace allowing bone regeneration and recovery in shorter time than patients in which it was not used.

Successful pregnancy and live birth after intrauterine administration of autologous platelet-rich plasma in a woman with recurrent implantation failure: A case report

Platelets contain a significant amount of growth factors that have positive effects on local tissue repair and endometrial receptivity. Here we present a 45-yr-old woman with primary infertility and two failed in vitro fertilization (IVF) cycles who was candidate to receive donor eggs. Five consecutive frozen-thawed embryo transfer cycles with good quality embryos were performed within 2 yr. With the diagnosis of recurrent implantation failure (RIF), the patient was treated for improving endometrial receptivity with intrauterine administration of autologous platelet-rich plasma (PRP), 24 hr before embryo transfer. The patient gave birth to a healthy baby boy weighing 2350 gr in the cesarean section. Extensive literature search suggests that this is the first successful pregnancy after administration of PRP in a woman with RIF. Local administration of PRP before embryo transfer may play a vital role in successful implantation .

Platelet-rich plasma intra-articular injections as an alternative treatment for knee osteoarthritis: a systematic review

Abstract Knee osteoarthritis is a degenerative joint disease characterized by cartilage degeneration and hypertrophic lesions of the epiphyseal bone. It is a disabling condition that causes difficulties of locomotion and severe complications in case of inappropriate treatment. There is growing evidence proving the beneficial effects of using platelet-rich plasma (PRP) in the treatment of knee osteoarthritis. The aim of the present paper is to review the recent scientific literature on the treatment of knee osteoarthritis with platelet-rich plasma presenting the current opinion on this subject. Methods: We analys several studies about PRP who were identified using online databases: EBSCO, ScienceDirect, Scopus and PubMed. Results: After the primary analysis we selected a total of 23 relevant studies. The analysis focused on different PRP administration techniques and methods used in knee osteoarthritis. Conclusions: PRP is most widely used in incipient and moderate symptomatic knee osteoarthritis. Most studies show a significant decrease in pain and significant improvement in joint functionality. These results were mostly obtained after a short follow-up period (6 months-1 year) and also this treatment has a small number of side effects.

A Systematic Review of Platelet-Rich Plasma in the Management of Upper Limb Tendinopathies

Currently, gold standards for treating upper-limb tendinopathies include steroid injections and operative treatment. However, these present a list of potential complications and hence, interest in alternative interventions, such as platelet-rich plasma (PRP), is growing. We review the recent high-level evidence discussing the use of PRP and its efficacy on three upper limb tendinopathies; lateral epicondylitis, rotator cuff tears, and impingement syndrome. A literature search was performed using PubMed and the Cochrane Library. Level 1 and level 2 literature was included. Main outcomes included function, pain, and biological healing. Fifteen studies were included (13 randomized control trials (RCTs) and 2 systematic reviews). Three RCTs reported increased benefit of PRP compared to corticosteroid (CS) injections and laser therapy. Other studies reported that PRP, CS, local anesthetic, and autologous whole blood are all beneficial. Benefits of PRP significantly increased in the long term. A mixture of results, potentially related to different methods of PRP administration. One study reports significant benefit when PRP used during decompression surgery. The variability of factors suggests that there is a need for standards of PRP to be set. However, even with such variability, PRP may be used as a safe and effective treatment for epicondylitis. The benefit of PRP use in rotator cuff repair augmentation is mixed and further evidence is needed to reach any conclusion for the use of PRP in subacromial decompression. Additional research is needed to determine optimum dosage and administration methods. This article discusses new treatments for diseases involving the shoulder and elbow including tennis elbow, rotator cuff tendon tears, and impingement syndrome. This method of treatment is known as platelet-rich plasma (PRP). PRP is a substance which is gathered from the patients’ own blood and introduced to sites of tendon injuries via injection or as a gel. This substance includes factors that speed healing and recovery of these injured tendons. This in turn allows for reduction in pain and improvement in function of joints. Our review shows promising results for the use of PRP in treating these conditions. Future works surrounding the use of platelet-rich plasma (PRP) will need to determine a gold standard for preparation of PRP. They will also attempt to establish the best practice for dosing and administering the substance. Future studies will aim to provide guidelines for bringing PRP into clinical practice.

Effect of local administration of platelet-rich plasma (PRP) on peripheral nerve regeneration: An experimental study in the rabbit model.

Twenty-eight Japanese white rabbits were used. A 15-mm sciatic nerve defect was created on the left limb. The resected nerve was used as a reverse autologous nerve. The rabbits were randomly divided into two groups. In group A (n = 10), only nerve grafting was performed. In group B (n = 18), nerve grafting was performed with local PRP administration. Right limbs were used as control (group C, n = 28). The rabbits in each group were equally divided into two subgroups based on the evaluation period of 4 and 12 weeks after grafting. Electrophysiological evaluation, muscle wet-weight, histological evaluation, and multiple immunofluorescence staining were performed to investigate the regenerative effect of PRP. The mean regenerative axon diameter of the graft portion in group B (2.02 ± 0.22-μm) was significantly larger than that in group A (1.89 ± 0.16-μm) at 4 weeks. The regenerative axon number at the distal portion showed a greater increase in group B (9017 ± 2224/mm2 ) than in group A (4955 ± 3117/mm2 ) at 12 weeks. Electrophysiological evaluation and muscle wet-weight revealed no significant differences. On immunohistological evaluation, the number of activated SCs increased to a larger extent in group B (188 ± 90/mm2 ) than in group A (117 ± 51/mm2 ). Local PRP administration increases the regenerative axon diameter and the regenerative axon number at the distal portion. PRP accelerates SC proliferation in vivo.

Combined platelet-rich plasma and lipofilling treatment provides great improvement in facial skin-induced lesion regeneration for scleroderma patients

BackgroundThe use of stem cells, including mesenchymal stem cells (MSCs), for regenerative medicine is gaining interest for the clinical benefits so far obtained in patients. This study investigates the use of adipose autologous tissue in combination with platelet-rich plasma (PRP) to improve the clinical outcome of patients affected by systemic sclerosis (SSc).MethodsAdipose-derived mesenchymal stem cells (AD-MSCs) and PRPs were purified from healthy donors and SSc patients. The multilineage differentiation potential of AD-MSCs and their genotypic–phenotypic features were investigated. A cytokine production profile was evaluated on AD-MSCs and PRPs from both healthy subjects and SSc patients. The adipose tissue-derived cell fraction, the so-called stromal vascular fraction (SVF), was coinjected with PRP in the perioral area of SSc patients.ResultsHistopathological and phenotypical analysis of adipose tissue from SSc patients revealed a disorganization of its distinct architecture coupled with an altered cell composition. Although AD-MSCs derived from SSc patients showed high multipotency, they failed to sustain a terminally differentiated progeny. Furthermore, SVFs derived from SSc patients differed from healthy donors in their MSC-like traits coupled with an aberrant cytokine production profile. Finally, the administration of PRP in combination with autologous SVF improved buccal’s rhyme, skin elasticity and vascularization for all of the SSc patients enrolled in this study.ConclusionsThis innovative regenerative therapy could be exploited for the treatment of chronic connective tissue diseases, including SSc.

Platelet-rich plasma administration has benefit for infertile women with thin endometrium in frozen blastocyst-stage embryos transfer program

Platelet-rich plasma administration has benefit for infertile women with thin endometrium in frozen blastocyst-stage embryos transfer program