Benefits Of Platelet-rich Plasma Research Articles

PATH-2 TRIAL: PLATELET-RICH PLASMA FOR ACUTE ACHILLES TENDON RUPTURE. TWO-YEAR FOLLOW-UP OF THE RANDOMIZED, PLACEBO-CONTROLLED, SUPERIORITY TRIAL

BackgroundThe PATH-2 trial found no evidence of a benefit of Platelet Rich Plasma (PRP) injection versus a placebo after Achilles tendon rupture (ATR) at six-months. ATR often leave longer-term functional deficiencies beyond six-months. This study aim is to determine if PRP affect tendon functional outcomes at two-years after rupture.Study designRandomised multi-centre two-arm parallel-group, participant- and assessor-blinded, superiority trial.MethodsAdults with acute ATR managed non-surgically were recruited in 19 UK hospitals from 2015 to 2019. Exclusions were insertion or musculotendinous injuries, leg injury or deformity, diabetes, haematological disorder, corticosteroids and anticoagulation therapy. Participants were randomised via an online system 1:1 to PRP or placebo. Primary outcome was Achilles Tendon Rupture Score (ATRS) at two-years. Secondary outcomes were pain, Patient-Specific Functional Scale (PSFS), SF-12 and re-rupture. Assessors were blinded. Intention-to-treat and Compliance Average Causal effects (CACE) analyses were carried out. Consistency of effects across subgroups age, BMI, smoking and gender were assessed using Forest plots. Pearson's correlation was used to explore ATRS correlation with blood and growth factors.Results216/230 (94%) participants completed the 6-months follow-up were contacted. 182/216 (84%) completed the two-year follow-up. Participants were aged mean 46 (SD 13.0), 57 female/159 male. 96% received the allocated intervention. Two-years ATRS scores were 82.2 (SD 18.3) in the PRP group (n=85) and 83.8 (SD 16.0) in the placebo group (n=92). There was no evidence of a difference in the two-years ATRS (adjusted-mean difference −0.752 95%CI −5.523 to 4.020, p=0.757), or in any secondary outcome, and no re-rupture between at two-years. Neither PRP cellular or growth factors correlated with the two-year ATRS.ConclusionPRP did not improve patient-reported function or quality of life two-years after acute Achilles tendon rupture, compared with placebo, indicating that PRP offers no patient benefit in the longer term.

Latin American consensus for the treatment of focal chondral lesions of the knee

IntroductionA consensus is useful for topics that can be common in clinical practice and controversial in some aspects of its treatment. ObjectivesTo establish a consensus among the Latin American society of arthroscopy, articular reconstruction and sports medicine (SLARD) for treating focal chondral lesions of the knee. MethodsA formal consensus was conducted among 3 groups of surgeons from SLARD with a special interest in cartilage. First, the steering group (n = 9) created a list of 21 statements on controversial topics and compiled a review of the literature for each topic. Second, the rating group (n = 19) gave a score to each statement according to their agreement with it, over 2 rounds (score: 1-9). Median scores and agreement levels were calculated and each statement was categorized as inappropriate, uncertain, or appropriate. Finally, the lecture group (n = 24) evaluated the appropriateness and clinical relevance of each statement. ResultsDuring the first round, there was strong agreement on 5% of the statements, relative agreement on 14%, and lack of consensus on 81% of statements. After the second round, there was strong agreement on 57% of statements, with 43% having relative agreement and no statement having a lack of consensus. The lecture group approved all the statements. ConclusionsSLARD arrived at a consensus on the 21 statements proposed. This consensus includes a literature review and clinical experience, which represents the expert opinion of a society. Strong agreement was found in the advantages of using arthroscopy to diagnose chondral lesions, preinjury level as an age modification of treatment, superiority of nanofractures compared to microfractures, advantages of adding scaffolds, benefits of platelet-rich plasma in the midterm and faster return to sport with osteochondral autografts.

Evaluation of Dentist Perception of Platelet Rich Plasma (PRP) for Accelerated Tooth Movement - Cross Sectional Survey.

The current survey was conducted to assess the knowledge, awareness and perception of platelet-rich plasma (PRP) on accelerated tooth movement among dentist present in the state of Tamil Nadu. Tamil Nadu dentists were the subjects of the cross-sectional questionnaire survey. 500 participants completed self-administered questionnaires about their knowledge, awareness, and perception of PRP's effect on accelerated tooth movement. The Statistical Package for the Social Sciences (SPSS) (V 22.0) was used to do the statistical analysis. It computed the frequency distribution.The result showed that 466 (93.2%) had prior knowledge of PRP, whereas 34 (6.4%) had no previous experience with it. A total of 156 (31.2%) dentists were aware that PRP procedures are used for teeth rotation and canine retraction.15.2% of participants stated that PRP facilitates accelerated tooth movement.Therefore, results of the study show that the dentists were a little aware of PRP as an additional therapeutic strategy for accelerating tooth movement.More awareness required among the dentist regarding application and its benefits of PRP in accelerated tooth movement.

Platelet-Rich Plasma: Advances and Controversies in Hair Restoration and Skin Rejuvenation.

Platelet-rich plasma (PRP) and its combined therapeutic modalities have catalyzed new possibilities in dermatology; however, limitations in evidence and lack of consensus remain among clinicians regarding optimal composition, protocol, technique, and application. To provide an update and analysis of the evidence for PRP in hair restoration and skin rejuvenation through review of recent available data, highlighting controversies and expert insights to guide future studies, and stimulate discourse and innovations benefitting patients. A structured review and expert analysis of PubMed publications before October 2023, with a focus on recent literature from January 2020 through October 2023. Growing literature supports the utility and benefits of PRP and related autologous products for applications for skin and hair, with strongest evidence for androgenetic alopecia and skin rejuvenation. However, this is limited by lack of consensus regarding best practices and protocols. Randomized, controlled trials with uniform metrics comparing outcomes of various compositions of autologous blood products, preparation methods, dosimetry, and frequency of treatments are still required. This will allow the medical discourse to grow beyond the realm of expert opinion into consensus, standardization, and more wide spread adoption of best practices that will benefit patients.

Benefits of platelet rich plasma (PRP) treatment on skin autografts and allografts in a burned patient

Wound healing is promoted by a series of growth factors, secreted from the alpha granules of the platelets. Platelet rich plasma (PRP) emerged as a clinical strategy to increase the physiologic concentration of platelets and its clinical use for a large spectrum of disorders is reported, with good results. Extensive burns represent a promising field for PRP use, those patients confronting challenging wound healing and poor long-term results. We present our initial clinical experience represented by a case of a 51-year-old male patient, severely burned, who benefited from sequential surgical treatment of deep burn wound excisions and coverage using autologous and allogenic skin grafts. PRP was added to this patient’s therapy in two stages, being injected and externally applied on the autografts in functional areas of the hands and the right upper arm region where both autografts and allografts were placed, with the exciting result of promoting allograft integration, long-term persistence and healing. Several literature data validate successful clinical applications of PRP in various therapies, including treatment of soft tissue injuries and chronic wounds, orthopedic surgery, burns, maxillo-facial surgery and elaboration of tissue-engineered products. Based on our preliminary experience and favourable reports in the literature, we encourage wider use of platelet rich plasma for immunomodulation and tissue-engineered constructs, due to its effects on local inflammatory response and role in enhancing the integration of various types of tissue grafts.

Cost-utility analysis and net monetary benefit of Platelet Rich Plasma (PRP), intra-articular injections in compared to Plasma Rich in Growth Factors (PRGF), Hyaluronic Acid (HA) and ozone in knee osteoarthritis in Iran

PurposeTo evaluate the cost-effectiveness of Platelet Rich Plasma (PRP), Plasma Rich in Growth Factors (PRGF), Hyaluronic Acid (HA) and ozone as effective treatment approaches in knee osteoarthritis management from Iran Health care perspective.MethodsA decision tree model was conducted to assess the cost-effectiveness of four common intra-articular treatment approaches in patients with mild and moderate knee osteoarthritis. The data on clinical effectiveness was obtained from a randomized controlled trial (RCT) conducted in Iran and used to estimate utility values. The direct medical costs were estimated according to tariffs for public medical centers and hospitals, approved by the Iran Ministry of Health and Medical Education in 2021. The incremental cost-effectiveness ratio (ICER) and the net monetary benefit (NMB) were used to evaluate the cost-utility analysis. Deterministic and probabilistic sensitivity analyses are performed to investigate the robustness of the results and account for the different sources of uncertainty.ResultsIn this study, HA intra-articular injection-related costs ($581.67/patient) were defined as the highest cost, followed by PRGF ($328.10/patient), PRP (318.58/patient), and Ozone (103.20/patient). According to the utility value, PRP and PRGF (0.68) have the same and the most utility among Intra-articular injections in knee osteoarthritis management. However, the PRP injection method was identified as the most cost-effective intervention due to its high NMB and ICER estimates. Based on the Monte Carlo Simulation, PR intervention, compared to other ones, was introduced as the dominant strategy regarding knee OA management, with a WTP of $10,000 for 100% of cases.ConclusionThe study result demonstrated that intra-articular injection of PRP, compare to other injections, is a cost-effective treatment option for patients with mild and moderate knee osteoarthritis. In addition, intra-articular injection of PRP was identified as the best injection, with the highest level of net monetary benefit, for knee OA management.

Effects of Platelet-Rich Plasma on Clinical Outcomes After Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis.

Background:Many studies have documented the use of platelet-rich plasma (PRP) alongside anterior cruciate ligament (ACL) reconstruction (ACLR) in the management of ACL injury, but evidence on the benefits of PRP in improving the clinical outcomes of ACLR is inconsistent.Purpose:To help in our understanding, we undertook a systematic review and meta-analysis of randomized controlled trials (RCTs) that evaluated the effects of PRP on patient-reported functional scores, the clinical assessments of knee function and structure, and complications.Study Design:Systematic review; Level of evidence, 1.Methods:We searched 9 online databases for RCTs published in English or Chinese that examined the effects of PRP on ACLR. The primary outcome measures were visual analog scale (VAS) for pain and International Knee Documentation Committee (IKDC) scores. The secondary outcomes included KT-1000 arthrometer, pivot-shift test, Lysholm and Tegner scores, tunnel widening, graft characterization, and complications. Subgroup analyses were performed according to time of assessments. Fixed- and random-effects models were selected for data analysis.Results:A total of 14 studies were included. When PRP was injected to graft tunnels, the pooled VAS scores of the 2 groups were similar (P = .31), and the subgroup analysis found that VAS and IKDC only improved at 3 months postoperatively (P = .0003 and P < .00001, respectively). When PRP was used at the bone–patellar tendon–bone harvest sites, VAS was decreased in the first 6 months postoperatively (P < .00001), whereas IKDC score was not remarkably different (P = .07). After PRP injection, Lysholm scores at 3 months postoperatively was different between the 2 groups (P < .00001), but the Tegner scores (P = .86), KT-1000 measurements (P = .12), the positive rate of pivot-shift test (P = .64), the enlargement of tunnels (femoral, P = .91; tibial, P = .80), and the characterization of grafts (P = .05) were not different. No difference in complications was found in either group.Conclusion:PRP applied alongside ACLR could reduce postoperative pain and improve knee function in the short and medium terms but is ineffective in the long term. PRP does not improve knee stability and the enlargement of tunnels and does not accelerate the healing of grafts. Further studies would be required.

The Biological Use of Platelet-Rich Plasma in Skeletal Muscle Injury and Repair

Platelet-rich plasma (PRP) is a blood product that contains several growth factors and active proteins. PRP is thought to be used autologously to assist in the repair of injured tissues as well as to treat pain at the site of injury. The mechanism behind PRP in regenerative medicine has been well investigated and includes the identification and concentration of released growth factors and exosomes. The benefits of PRP have been highly recommended and are used widely in orthopaedics and sports medicine, including repair of injured skeletal muscle. This current report summarizes some of the more recent studies in the use of PRP as it relates to muscle healing, in both the in vitro and clinical arenas.

The use of platelet-rich plasma in oral surgery: a systematic review and meta-analysis.

The aim of this systematic review and meta-analysis was to evaluate the benefit of platelet rich plasma (PRP) in oral surgery. We performed a systematic search of the literature. The GRADE system was used to assess the certainty of the body of evidence. We found 21 randomised controlled trials that met our inclusion criteria: 12 studies included patients with periodontal defects, five studies focused on healing of extraction sockets, three studies on sinus lift augmentation, and one study on periapical osseous defects. However, for the quantitative synthesis (meta-analysis), we evaluated "periodontal defects" studies only, since for other clinical contexts the number of studies were too low and the procedural heterogeneity was too high to allow pooling of data. PRP-containing regimens were compared to non-PRP-containing regimens. Primary outcomes for the evaluation of periodontal defects were probing depths, clinical attachment level, gingival recession, and radiographic bone defect. It is not usually clear whether or not the use of PRP compared to controls affects "probing depth" at long-term follow up; the between group differences were small and unlikely to be of clinical importance (i.e., very low quality of evidence). For the other outcomes analysed ("clinical attachment levels", "gingival recession", "bony defect"), we observed a very slight marginal clinical benefit of PRP compared to controls. The available evidence for these comparisons was rated as low quality as most of the studies selected showed inconsistency, imprecision, and risk of bias. Evidence from a comparison between the use in oral surgery of PRP-containing regimens compared to other regimens not-containing PRP was of low quality. The results of the meta-analysis, limited to studies in patients with periodontal defects, document that PRP was slightly more effective compared to controls not-containing PRP.

Efficacy of Platelet-Rich Plasma for the Treatment of Interstitial Supraspinatus Tears: A Double-Blinded, Randomized Controlled Trial

Background: The benefits of platelet-rich plasma (PRP) for the treatment of rotator cuff tears remain inconclusive, as it is administered either as an adjuvant to surgical repair or as a primary infiltration without targeting the index lesion, which could dilute its effect. Purpose: To determine whether PRP infiltrations are superior to saline solution infiltrations (placebo) at improving healing, pain, and function when injected under ultrasound guidance within isolated interstitial supraspinatus tears. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: In this single-center, double-blinded, randomized controlled trial, 80 adults with symptomatic isolated interstitial tears of the supraspinatus, confirmed by magnetic resonance arthrography, were randomized to PRP or saline injections. Each patient received 2 injections with a 1-month interval. The primary outcome was the change in lesion volume, calculated on magnetic resonance arthrography, at 7 months. The secondary outcomes were improvements in shoulder pain and the Single Assessment Numerical Evaluation (SANE) score at >12 months. Results: Preoperative patient characteristics did not differ between the 2 groups. At 7 months, there were no significant differences between the PRP and control groups in terms of a decrease in lesion size (–0.3 ± 23.6 mm3 vs –8.1 ± 84.7 mm3, respectively; P = .175); reduction of pain on a visual analog scale (VAS) (–2.3 ± 3.0 vs –2.0 ± 3.0, respectively; P = .586); and improvement in SANE (16.7 ± 20.0 vs 14.9 ± 29.0, respectively; P = .650), Constant (8.6 ± 13.0 vs 10.7 ± 19.0, respectively; P = .596), and American Shoulder and Elbow Surgeons (19.5 ± 20.0 vs 21.9 ± 28.0, respectively; P = .665) scores. At >12 months, there were no significant differences between the PRP and control groups in terms of a reduction of pain on a VAS (–3.3 ± 2.6 vs –2.3 ± 3.2, respectively; P = .087) or improvement in the SANE score (24.4 ± 27.5 vs 23.4 ± 24.9, respectively; P = .846). At 19.5 ± 5.3 months, the incidence of adverse effects (pain >48 hours, frozen shoulder, extension of lesion) was significantly higher in the PRP group than the control group (54% vs 26%, respectively; P = .020). Conclusion: PRP injections within interstitial supraspinatus tears did not improve tendon healing or clinical scores compared with saline injections and were associated with more adverse events. Registration: NCT02672085 (ClinicalTrials.gov identifier).

Can platelet-rich plasma be an alternative to surgery for resistant chronic patellar tendinopathy in sportive people? Poor clinical results at 1-year follow-up.

Patellar tendinopathy is a disease affecting particularly athletes. Platelet-rich plasma (PRP) injections have gained increasing interest for their potential benefits. Anyway, a tendon disease longer than 6 months should be considered as an indication for surgery. The aim of our study was to evaluate the efficacy of PRP in athletes with a severe chronic patellar tendinopathy longer than 6 months when surgery should be chosen. We enrolled 17 sport practitioners (19 patellar tendons) who did not want to undergo surgery and who are nonresponders to other conservative treatments. We treated them with PRP and calculated the results using the visual analog scale (VAS), the Victorian Institute of Sport Assessment-Patellar (VISA-P) score, and Tegner Activity Scale. Every test has been conducted at T0, T1 (4 months), and T2 (12 months). We found a poor improvement at T1 and a clinical worsening at T2 through VAS. VISA-P showed a medium improvement both at T1 and T2. Tegner scale did not show improvements. Our study was not able to remove the doubts about the benefits of PRP in patellar tendinopathy, confirming ambiguous certainties. Further investigations are needed to assess its effectiveness.

Effects of Aspirin on Growth Factor Release From Freshly Isolated Leukocyte-Rich Platelet-Rich Plasma in Healthy Men: A Prospective Fixed-Sequence Controlled Laboratory Study

Background: The benefits of platelet-rich plasma (PRP) are believed to be in part dependent on growth factor release after platelet activation. Platelet activation is complex and involves multiple mechanisms. One important mechanism is driven by cyclooxygenase 1 (COX-1)–mediated conversion of arachidonic acid (AA) to precursor prostaglandins that then mediate proinflammatory responses that trigger growth factor release. Acetylsalicylic acid (ASA; also known as aspirin) is known to irreversibly inhibit COX-1, thereby blocking AA-mediated signaling; however, it is unclear whether ASA use alters growth factor release from freshly isolated PRP. Purpose: To assess the effects of low-dose ASA use on activation of growth factor release from freshly isolated human PRP via AA and thrombin (TBN). Study Design: Controlled laboratory study. Methods: Twelve healthy men underwent blood collection and leukocyte-rich PRP (LR-PRP) preparation through a double-spin protocol to obtain baseline whole blood and PRP counts the same day. PRP was aliquoted into 3 groups: nonactivated, AA activated, and TBN activated. Immediately after activation, the concentrations of transforming growth factor β1 (TGF-β1), vascular endothelial growth factor (VEGF), and platelet-derived growth factor AB (PDGF-AB) were measured using enzyme-linked immunosorbent assays (ELISAs). The same 12 participants were then placed on an 81-mg daily dose of oral ASA for 14 days. Repeat characterization of whole blood and PRP analyses was done on day 14, followed by repeat ELISAs of growth factors under the same nonactivated and activated settings as previously stated. Results: Fourteen days of daily ASA had no effect on the number of platelets and leukocytes measured in whole blood and LR-PRP. Compared with nonactivated LR-PRP, AA- and TBN-mediated activation led to significant release of VEGF and PDGF-AB. In contrast, release of TGF-β1 from LR-PRP was observed only with activation by AA, not with TBN. Consistent with its inhibitory role in AA signaling, ASA significantly inhibited AA-mediated release of all 3 growth factors measured in this study. Although ASA had no effect on TBN-mediated release of VEGF and TGF-β1 from LR-PRP, ASA did partially block TBN-mediated release of PDGF-AB, although the mechanism remains unclear. Conclusion: Daily use of low-dose ASA reduces VEGF, PDGF-AB, and TGF-β1 expression in freshly isolated human LR-PRP when activated with AA. Clinical Relevance: Reduction in growth factor release attributed to daily use of low-dose ASA or other COX inhibitors can be mitigated when PRP samples are activated with TBN. Clinical studies are needed to determine whether activation before PRP injection is needed in all applications where ASA is in use and to what extent ASA may inhibit growth factor release in vivo at the site of injury.

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.

Osteochondritis dissecans—Does platelet rich plasma really help

Osteochondritis dissecans is a common disorder of knee and can be treated by various methods, depending on age of patient and stability of chondral fragment. In Osteochondritis dissecans ICRS type III lesion i.e. articular cartilage discontinuity but no dislocation, variable rate of union as well as high rate of non-union was observed in previous studies when treated with arthroscopic or open reduction and fixation. In previous study it has been also shown that platelet rich plasma help in fracture healing. In this study we are trying to extend the benefit of platelet rich plasma to Osteochondritis dissecans lesion. We took six patients with OCD, ICRS scale of OCD type III lesion. All Patients were operated Arthroscopiclly. Chondral flap of OCD lesion were fixed with stainless steel cannulated cancellous screw. To enhance union we used platelet rich plasma injections. .We access the union of chondral fragment to parent bone and knee function. Chondral fragment united to parent bone in all patients. To access knee function we used Tagner- Lysholm knee scoring system, in this study preoperatively score was 52.8 where as postoperatively it was 91.8. This study showed PRP is helpful in healing of chondral flap as all the chondral flap of osteochondral lesion united in this study.

Clinical Safety and Efficacy of Platelet-Rich Plasma in Wound Healing

Background: Platelet-rich plasma has been extensively used in several clinical settings. However, there still a lack of conclusive evidence concerning the benefits of platelet-rich plasma in the field of wound healing. We aimed to evaluate the safety and the efficacy of autologous platelet-rich plasma in acute wound healing. Methods: This prospective study enrolled forty adult patients of both sexes and aged between 18 - 50 years. All patients in need for split-thickness skin graft were included in our study. The donor sites were randomly divided into two equal halves: the platelet-rich plasma side, which was injected with recently activated platelet-rich plasma; and the control side, in which the conventional method of dressing was used. Measurement of the platelet count and transforming growth factor-B1 concentration in each platelet-rich plasma preparation and the whole blood was done for all patients. Clinical monitoring of the donor sites was done every 7 days for 3 weeks, regarding pain perception, epithelialization surface area and possible side effects of the platelet-rich plasma. Histopathological monitoring was done on the 7th postoperative day. Results: The platelet count was increased about 3.5 folds and transforming growth factor-B1 was increased 2.4 folds in the platelet-rich plasma compared to the patients’ blood. The platelet-rich plasma side had significantly lower pain scores at day 7 (4.8 ± 0.18 vs 5.9 ± 0.07) and day 14 (1.4 ± 0.11 vs 1.9 ± 0.09) postoperative (p = 0.002 and p = 0.004, respectively) and had significantly higher rate of epithelialization at day 7 (9.8 ± 0.35 cm2 vs 7.5 ± 0.32 cm2) and day 14 (38.4 ± 0.36 cm2 vs 36.9 ± 0.42 cm2) postoperative (p p = 0.039, respectively), while at day 21 postoperative, there was no significant difference between both sides. There was no significant difference between both sides regarding the incidence of complications. The platelet-rich plasma side showed intact epithelium, differentiation of the cells in stratum spongiosum and stratum granulosum, neovascularization and earlier collagen deposition. Conclusion: The platelet-rich plasma is safe and effective adjuvant in the management of acute wounds. However, we recommend for larger clinical trials for standardized method for PRP preparation and better understanding of the efficacy of this blood product.

Platelet-Rich Plasma Effects on Degenerative Disk Disease: Analysis of Histology and Imaging in an Animal Model

Introduction The current conservative and surgical modalities of treating degenerative disk disease are aimed at relief of symptoms. At this time, there is no cure for the degenerative process. Platelet-rich plasma (PRP) is a bioactive component of autologous whole blood. The indications for the use of PRP in the treatment of musculoskeletal diseases continue to expand. The mechanism of action for PRP is due to the release of healing factors from platelets. While clinical evidence strongly supports the use of PRP for certain conditions, the potential benefit of PRP in treating or preventing progression of degenerative disk disease has not been critically evaluated. There is a preliminary evidence that certain growth factors in PRP, such as PDGF and IGF-1, may be beneficial in slowing the progression of disease. The objective of this study is to analyze the early and late phase effects of PRP injection into the intervertebral disk using an animal model. Materials and Methods After obtaining IRB and Institutional Animal Care and Use Committee (IACUC) approval, the L4-L5 intervertebral disk of adult Sprague Dawley rats were injured with a 21-gauge needle in 24 rats. After injury, animals received either an acute injection of PRP collected from matched donor animals, a delayed (2 week) injection of PRP after the degenerative process had commenced, or no further intervention (sham PRP). Magnetic resonance imaging was performed for each group at 0, 2, and 4 weeks. Three rats were euthanized at 2 weeks post-PRP injection, as well as three shams and a control rat. We collected traumatized and adjacent discs in test subjects, along with discs from control subjects. Each disk was sectioned axially and sagittally followed by histopathological and immunohistochemical analysis. Results The disks treated with PRP, both in the acute and delayed administration, had less degeneration than the sham group. The sham group had clear degenerative changes with near total loss of organizational structure, large amounts of empty space, fibrous (scar) tissue, and large numbers of inflammatory cells (Fig. 2). The PRP-treated group had annulus fibers that were damaged with some empty spaces and inflammatory cells. However, there was a maintenance of the ring structure and the nucleus pulposus, while having irregular borders and overall deceased size, appeared to have a healthy central portion (Fig. 3). Overall, the PRP treated group retained more normal morphologic features of the control disks (Fig. 1), contained fewer inflammatory cells than those not receiving PRP, and did not appear as damaged on MRI. The disk height did not seem to be greatly different between all three groups at the 2 weeks interval. Conclusion The needle puncture technique was validated as an effective method for creating a degenerative disk model. The administration of PRP has a protective effect on damaged disks and decreases the amount of inflammation at the 2-week interval and the 6-week interval. I confirm having declared any potential conflict of interest for all authors listed on this abstract Yes Disclosure of Interest R. Mcguire Grant/Research support from: spinal usa, stryker, Consultant for: synthes Chen WH, Liu HY, Lo WC, et al. Intervertebral disk regeneration in an ex vivo culture system using mesenchymal stem cells and platelet-rich plasma. Biomaterials 2009;29:5523–33. Epub 2009 Jul 30 Sawamura K, Ikeda T, Nagae M, et al. Characterization of in vivo effects of platelet-rich plasma and biodegradable gelatin hydrogel microspheres on degenerated intervertebral discs. Tissue Engineering Part A 2009;12:3719–3727 Nagae M, Ikeda T, Mikami Y, et al. Intervertebral disk regeneration using platelet-rich plasma and biodegradable gelatin hydrogel microspheres. Tissue Engineering 2007;1:147–158 Akeda K, An HS, Pichika R, et al. Platelet-rich plasma (PRP) stimulates the extracellular matrix metabolism of porcine nucleus pulposus and anulus fibrosus cells cultured in alginate beads. Spine 2006;31(9):959–966 Chen WH, Lo WC, Lee JJ, et al. Tissue-engineered intervertebral disk and chondrogenesis using human nucleus pulposus regulated through TGF-beta1 in platelet-rich plasma. Journal of Cellular Physiology 2006;209(3):744–754 Elliot DM, Yerramalli CS, Beckstein JC, Boxberger JI, Johannessen W, Vresilovic EJ. The effect of relative needle diameter in puncture and sham injection animal models of degeneration. Spine 2008;33(6):588–596

A New Innovative Therapy for Sports Related Soft Tissue Injuries: Platelet-Rich Plasma (PRP)

Introduction: Platelet-rich plasma (PRP) is the cellular component of plasma that settles after centrifugation, and contains numerous growth factors. There is increasing interest in the sports medicine about providing endogenous growth factors directly to the injury site, using autologous blood products such as PRP, to potentially facilitate healing and earlier return to. Despite this interest, and apparent widespread use, there is a lack of high-level evidence trials assessing the efficacy of PRP. Systematic review: We performed a systematic review of the literature and included clinical studies on PRP injections for ligament, muscle or tendon injuries. A few randomized controlled clinical trials have assessed the efficacy of PRP injections and none have demonstrated scientific evidence of efficacy. Scientific studies should be performed to assess clinical indications, efficacy, and safety of PRP, and this will require appropriately powered randomized controlled trials with adequate and validated clinical and functional outcome measures and sound statistical analysis. Original research: Our group recently studied the effects of a platelet-rich plasma injection in patients with chronic midportion Achilles tendinopathy at 1-year follow-up in a randomized controlled trial; Fifty-four patients, aged 18 to 70 years, with chronic tendinopathy were randomized to receive either a blinded injection containing platelet-rich plasma or saline (placebo group) in addition to an eccentric training program. The validated mean Victorian Institute of Sports Assessment-Achilles score improved in both the platelet-rich plasma group and the placebo group after 1 year. There was no significant difference in increase between both groups (adjusted between-group difference, 5.5; 95% confidence interval, −4.9 to 15.8, P = .292). This randomized controlled trial showed no clinical and ultrasonographic superiority of platelet-rich plasma injection over a placebo injection. Overall conclusion: Based on the systematic review and original research, the potential risks involved with PRP are fortunately very low. PRP got the potentiality to facilitate healing and earlier return to sport after musculoskeletal injury, but benefits remain unproven to date and there is a need for high quality studies with a randomized design. Aspetar is currently performing a level I evidence research project into the benefits of PRP in muscle injuries.

Platelet-Rich Plasma in Sinus Augmentation Procedures: A Systematic Literature Review: Part II

Although platelet-rich plasma (PRP) has been extensively studied for over a decade, there are no definitive reports, which prove the benefit of using PRP in sinus augmentation procedures. In addition, no systematic literature review has been done to report the benefit of treatment outcome in patients who received PRP in conjunction with bone/bone substitutes in maxillary sinus augmentation procedures. Therefore, it can be rightly stated that evidence for an adjunctive benefit of using PRP with bone grafts in sinus augmentation procedures is equivocal and inconclusive. : The objective of this systematic literature review was to examine this literature in determining whether PRP with bone and bone substitutes leads to more rapid and effective bone regeneration clinically, radiographically, and histologically with sinus augmentation procedures and was there any clinical data parallel to animal experiments providing clinical evidence in sinus augmentation procedures? A systematic review of randomized clinical trials of at least 6 months duration was conducted comparing PRP and bone/bone substitutes (test group) to bone/bone substitutes (control group) alone. Electronic databases such as MEDLINE and CENTRAL (Cochrane central register of controlled clinical trials) were searched for relevant articles. The reference list of all included articles was searched along with unpublished clinical trials whose abstracts were available. Although, there is a lack of human studies, which show benefit of using PRP in conjunction with bone grafting materials, it can be stated that use of PRP does lead to early regeneration and reduction in healing time of soft and hard tissues. However, no significant statistical or clinical benefit was reported from studies that would satisfy the inclusion criteria. This study answers the question very clearly that at this point of time, there is no human study that strongly supports the benefit of using PRP in sinus augmentation procedures. There is a paucity of clinically controlled trials regarding benefits of PRP in sinus augmentation procedures. Theoretically, it seems to have significant beneficial effects on the soft and hard tissue healing; however, the disparity in study design, surgical techniques, and different outcome assessment variables used, makes it difficult to assess the practical benefit of its clinical use. Although no obvious positive effects of PRP on healing of bone graft material in maxillary sinus augmentation procedures were noted, the handling of the particulate bone grafts was improved.

Effects of Platelet-rich Plasma on Osteoblast and Osteoclast Number in Canine Mandibular Bone Grafts

Statement of the Problem: Platelet-rich plasma (PRP) was first reported as enhancing autologous mandibular bone grafts in 1998. Since then a number of studies have reported contradictory results on the benefits of PRP used in various types of bone grafts. A recent study from our laboratory reported that the use of PRP in conjunction with autologous mandibular bone grafts in canines resulted in an increased volume of new bone in the graft site at 1 and 2 months, but no difference was seen at 3 and 6 months. This increase was not due to an increase in the rate of bone formation. Additionally, removal of non-viable grafted bone was greater at 1 and 2 months with PRP. We report here on the comparative number of osteoblasts (ob) and osteoclasts (oc) in PRP and non-PRP autologous mandibular bone grafts in canines at 1, 2, 3, and 6 months. Materials and Methods: Twelve adult male dogs had bilateral inferior border marginal resections that measured 2cm x 1cm between the mandibular angle and the mental foramen. Corticocancellous bone harvested from the posterior ilium of each animal was particulated in a bone mill, and equal volumes were placed in each defect. Grafts were stabilized with Vicryl mesh secured to the mandible with two 1.5 x 6mm titanium screws. PRP was produced from 20cc of peripheral blood from each animal. The right side graft in each animal had PRP added while the left side had nothing added. All dogs were maintained on soft diets for 2 weeks postoperatively. Three animals were sacrificed at 1, 2, 3, and 6 months, respectively. The grafts along with adjacent bone were harvested at the time of sacrifice, fixed, dehydrated, and embedded in Spurr’s undecalcified. Two median sections were cut, polished and mounted. Sections were stained with Sanderson’s rapid bone stain and Alizarin red, and examined with a Leitz bright-field microscope. Method of Data Analysis: Twenty fields from each section were analyzed at 100x. The total number of osteoblasts/field were counted. The total number of osteoclasts/field were counted along with the visible number of nuclei in each cell. These numbers were compared for PRP and non-PRP grafts for all times. Results: The comparative numbers of ob and oc for the PRP and non-PRP grafts for all times are expressed as ratios. At 1 month the ratio of ob in the PRP grafts compared to the non-PRP grafts was significantly greater at 1.65:1. The ratio of oc in the PRP grafts compared with the non-PRP grafts is also significantly greater at 2.01:1. At 2 months the ratio of ob in the PRP grafts compared to the non-PRP grafts is 1.02:1, and the ratio of oc in the PRP grafts compared to the non-PRP grafts is 1.21:1. The ratio of ob in the PRP grafts compared to the non-PRP grafts at 3 months is 1:1.1, and the ratio of oc in the PRP grafts compared to the non-PRP grafts is 1.2:1. At 6 months, the ratio of ob in the PRP grafts compared to the non-PRP grafts is 1:1.12, and the ratio of oc in the PRP grafts compared to the non-PRP grafts is 1:1.02. The differences in the number of ob and oc at 2, 3, and 6 months are not statistically significant. The number of oc nuclei seen at the different times, with or without PRP ranged from 3 to 16. There was no statistically significant difference in the number of nuclei in oc with or without PRP at any time. Conclusion: The enhanced healing of autologous bone grafts using PRP that has been reported in previous studies may be due to an increased number of both ob and oc in the graft site. This may be due to increased recruitment and differentiation of ob and oc precursor cells in the PRP graft sites. In the study reported here this effect appears early in the healing process, and is no longer evident after 1 month.

Sinus floor augmentation with simultaneous placement of dental implants in the presence of platelet‐rich plasma or recombinant human bone morphogenetic protein‐7

The aim of the present study was to evaluate the possible benefit of platelet-rich plasma (PRP) in sinus grafting as compared with recombinant human bone morphogenetic protein-7 (rhBMP-7). For this purpose, we performed a bilateral sinus augmentation with anorganic bovine bone and simultaneous insertion of a titanium screw implant in five miniature pigs. Six hundred microliters of PRP and 15%-vol. autologous bone, which was collected with a trap during preparation of the implant recipient site, were added to the right sinus and 420 microl rhBMP-7 to the left sinus. A polychrome sequential labeling was performed. The animals were sacrificed 6 weeks after surgery. Undecalcified ground sections were evaluated by microradiography, digitized histomorphometry and under fluorescent light. The mean bone-implant contact using rhBMP-7 was 45.8% and 5.7% under PRP (P=0.002). The mean height of newly mineralized bone in the augmented area using rhBMP-7 amounted to 8.3 mm as opposed to 3.6 mm under PRP (P=0.013). Using PRP, the mean area of the newly formed bone was enhanced (51.3%) as compared with rhBMP-7 (33.1%); however, this difference was not statistically significant (P=0.081). In conclusion, under the selected experimental conditions the use of rhBMP-7 led to superior outcomes with regard to the osseointegration of dental implants and the height of new bone as compared with the use of PRP.