Local Platelet-rich Plasma Research Articles

A comparative study of effectiveness of local injection of autologous platelet rich plasma and injection corticosteroid solution in treatment of plantar fasciitis

<p class="abstract"><strong>Background:</strong> The heel pain is the most common problem worldwide and it was associated with plantar fasciitis (PF). The condition of treatment is very complex. Platelet-rich plasma (PRP) and injection of corticosteroids is the treatment of PF. This study was designed to access the effect of local PRP and local corticosteroid injection in PF patients.</p><p class="abstract"><strong>Methods:</strong> Sixty patients (between 29 to 60 years of age) with chronic PF were randomized prospectively in single tertiary care center in India. The study conducted from December 2013 to December 2015. All the patients were enrolled according to inclusion criteria and divided into two groups randomized. In group A (n=30) received PRP and group B (n=30) received corticosteroids injections. Visual analog scales (VAS) were filled by all the included patients. The follow-up scheduled at one and six months after complete enrolment of patients.<strong></strong></p><p class="abstract"><strong>Results:</strong> Between both the groups the significantly different observed at one and six months follow-up from the baseline. At one month follow-up significantly improvement in mean VAS score were observed in group B (p<0.001). At six months follow-up significantly improvement in mean VAS score were observed in group A (p<0.001).</p><p class="abstract"><strong>Conclusions:</strong> The present study concluded from the significance difference between both the groups proved promising form of treatment in chronic PF patients. Both the treatment was safe and effective in relieving pain improving function at different time period.</p><p> </p>

The effect of platelet-rich plasma injection on post-internal urethrotomy stricture recurrence

Local injection of platelet-rich plasma (PRP) is postulated to work by delivering growth factors and cytokines that recruit healer cells and enhance recovery process at the injection site. As new scar formation leads to stricture recurrence after internal urethrotomy, we proposed to improve post-internal urethrotomy stricture recurrence rate by injecting local submucosal PRP at the time of urethrotomy. From July 2015 to June 2018, 87 male patients with symptomatic bulbar urethral stricture (diagnosed by retrograde urethrography) randomized into two groups of internal urethrotomy and submucosal normal saline injection (control group, 43 patients), and internal urethrotomy with submucosal autologous platelet-rich plasma injection (PRP injection group, 44 patients). According to the endpoint, which happened sooner, each patient was followed at 3-month intervals for 2years after internal urethrotomy or until urethral stricture recurrence. Twelve-month recurrence rates were 26.82 and 9.09% in the control and the PRP injection groups, respectively (p 0.032). After 2years of follow-up, stricture recurrence was identified in 18 (43.90%) and 9 (21.95%) patients in the control and the PRP injection groups, respectively (p 0.34). In our study, submucosal PRP injection at the site of internal urethrotomy decreased the rate of stricture recurrence a year after the intervention. This protective effect lasted for 24months, at least. Submucosal PRP injection at the time of internal urethrotomy also decreased the length of stricture in case of recurrence.

Is local platelet-rich plasma injection clinically superior to hyaluronic acid for treatment of knee osteoarthritis? A systematic review of randomized controlled trials

BackgroundIn this study, we evaluated whether platelet-rich plasma (PRP) is superior to hyaluronic acid (HA) in the treatment of knee osteoarthritis.MethodsThe Cochrane Central Register of Controlled Trials, PubMed, and Embase databases were searched for English-language, human in vivo studies on the treatment of symptomatic knee osteoarthritis with intra-articular PRP compared with HA. The following keywords were used for the search: “platelet-rich plasma,” “PRP,” “platelet-rich fibrin,” “PRF,” “platelet,” “plasma,” “arthritis,” “osteoarthritis,” “gonarthrosis,” and “degeneration.”ResultsSeven articles reporting 908 patients and 908 knees were analyzed, including 44% men and 56% women with a mean age of 59.8 years. All studies met the minimal clinically important difference criteria and showed statistically significant improvements in clinical outcomes, including pain, physical function, and stiffness, with PRP treatment. All except two studies showed significant differences between PRP and HA regarding clinical outcomes of pain and function.ConclusionsPRP intra-articular injection of the knee may be an effective alternative treatment for knee OA, especially in patients with mild knee OA. Although some studies suggested that the effect of PRP was no better than HA, we found that it was no worse. A large, multicenter, randomized trial is needed to further assess the efficacy of PRP treatment for patients with knee OA.Trial registrationPROSPERO, CRD42016048394. Registered on October 2, 2016).

A meta-analysis on evidence of platelet-rich plasma for androgenetic alopecia

Background:Platelet-rich plasma (PRP) treatment has gained popularity among different surgical specialities for improving various conditions. Androgenetic alopecia (AGA) is a common disorder, with possible psychosocial implications. Plastic surgeons have increased the practice of PRP injections for hair restoration. A meta-analysis on this topic was performed comparing local injection of PRP versus control to investigate the efficacy of local PRP injections in AGA.Methods:We performed a systematic literature search. The increase in number of hairs was the primary outcome. Secondary outcomes were the increase of hair thickness and the percentage increase in hair number and thickness.Results:Seven studies involving 194 patients were retrieved and included in the present analysis. A significantly locally increased hair number per cm2 was observed after PRP injections versus control (mean difference [MD] 14.38, 95% confidence interval [CI] 6.38–22.38, P < 0.001). Similarly, a significantly increased hair thickness cross-section per 10−4 mm2 (MD 0.22, 95% CI 0.07–0.38, P = 0.005) favoring PRP group. The pooled results did not show a significant percentage increase in hair number (MD 18.79%, 95% CI − 8.50–46.08, P = 0.18), neither hair thickness (MD 32.63%, 95% CI − 16.23–81.48, P = 0.19) among patients treated with PRP.Conclusion:Local injection of PRP for androgenic alopecia might be associated with an increased number of hairs in the treated areas with minimal morbidity, but there is clearly a lack of scientific evidence on this treatment modality. Further studies are needed to evaluate the efficacy of PRP for AGA.

Treatment of resistant tennis elbow by a novel technique: Platelet-rich plasma injection and drilling of lateral humeral epicondyle

Introduction: Tennis elbow is a common disease in orthopedic surgery. Recently, the high-rate outcomes of local injection of platelet-rich plasma (PRP) were reported. This study was conducted to evaluate and compare the results of combining the percutaneous drilling of lateral humeral epicondyle and local injection of PRP for resistant tennis elbow to other more invasive techniques. Patients and Methods: Between January 2014 and December 2015, 25 patients underwent this study. The patients underwent percutaneous drilling of lateral humeral epicondyle and local injection of PRP. Results: The average follow-up time was 18 months (range: 12–27 months). Eighteen patients (72%) were rated as having excellent results, 4 patients (16%) were rated as having good results, and 3 patients (12%) were rated as having a poor result without any improvement. Conclusions: Combining the percutaneous drilling of lateral humeral epicondyle and local PRP injection in tennis elbow improved the results and compared favorably with other techniques.

Extracorporeal Shockwave Therapy Increases Growth Factor Release from Equine Platelet-Rich Plasma In Vitro.

Extracorporeal shockwave therapy (ESWT) and platelet-rich plasma (PRP) are common treatments for soft tissue injuries in horses. Shockwave triggers cell specific responses to promote healing. Growth factors released from PRP also promote healing. It has been hypothesized that greater growth factor release would amplify the healing process. The combination of ESWT and PRP could promote healing in injured tendons and ligaments in the horse. The objective of this study was to determine if application of shockwaves to PRP samples increases the concentration of transforming growth factor-β1 (TGF-β1) and platelet-derived growth factor ββ (PDGF-ββ) released from the platelets in vitro. PRP was produced from blood drawn from six horses. The PRP from each horse was exposed to the following treatments: (1) positive control (freeze-thaw cycle), (2) untreated negative control, or shockwaves with either (3) a "standard probe" (ESWT-S) with a 2 cm focal width and medium energy density or (4) a "power probe" (ESWT-P) with a 1 cm focal width and high energy density. After each treatment, the samples were centrifuged, and the supernatant was harvested. The supernatant was then used for growth factor quantification via commercially available ELISA kits for TGF-β1 and PDGF-ββ. Concentrations of TGF-β1 and PDGF-ββ in PRP that underwent a freeze-thaw cycle were significantly increased compared with all other treatments. Both ESWT-S and ESWT-P resulted in significantly increased TGF-β1 concentrations, 46 and 33%, respectively, when compared with the negative control. Both ESWT-S and ESWT-P resulted in significantly increased PDGF-ββ concentrations, 219 and 190%, respectively, when compared with the negative control. These data indicate that the application of ESWT to PRP increases the expression of growth factors in vitro. This suggests that the combination therapy of local PRP injection followed by ESWT may stimulate release of growth factors from platelets after they have been injected into the area of injury. The combination of PRP and ESWT might result in synergism of two modalities previously utilized individually for tendon and ligament injuries in horses.

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.

TREATMENT OF MEDIAL EPICONDYLITIS WITH LOCAL INJECTION OF PLATELET RICH PLASMA

Introduction:: Medial epicondylitis is commonly referred to as ‘‘golfer’s elbow,’’ and is characterized by pathologic changes to the musculo-tendinous origin at the medial epicondyle. Actually, epicondylitis is not an inflammatory process, but it is a tendinosis that results from tendon microscopic tearing, followed by an incomplete reparative response. Several treatment options are available as non???steroidal anti-inflammatory medications, physiotherapy, extracorporeal shock wave therapy, local steroid injections and more recently local injection of platelet rich plasma (PRP). Surgery reserved for resistant cases when the mentioned modalities fail. Patients and method: This study included 27 patients presented to El???Hadara University Hospital with chronic symptomatic medial epicondylitis for more than 6 months. All cases received single local injection of PRP and followed up for 3 months after injection. Patientsassessment was done using the VAS and DASH scoring system at the initial visit (before injection) and through the follow up period at 2 weeks, 6 weeks and 12 weeks.Results: Local injection of PRP in cases of medial epicondylitis was a successful method of treatment. When the baseline VAS and DASHscores were compared with the scores at 3 months follow-up, the results showed significant improved across time. Conclusion: local PRP injection significantly reduced pain and increased function in patients with chronic medial epicondylitis

Efficacy of Early Fusion With Local Bone Graft and Platelet-Rich Plasma in Lumbar Spinal Fusion Surgery Followed Over 10 Years.

Study Design:Prospective clinical study.Objective:Many oral surgeons use platelet-rich plasma (PRP) for bone defects, but the efficacy of PRP for spinal arthrodesis remains uncertain. The objective was to compare the efficacy of autologous local bone graft and PRP with local bone graft alone for promotion of bony union in posterolateral lumbar fusion (PLF) surgery, with investigation of the safety of PRP over 10 years.Methods:A prospective study was conducted in 29 consecutive patients who underwent one-level PLF at L4/5 for degenerative lumbar disease. Local bone on the left (control) side and local bone with PRP on the right side were grafted. The fusion area and absorption of grafted bone at 58 regions were determined using computed tomography at 2 weeks and 3, 6, and 12 months after surgery.Results:Average bone fusion areas on the PRP side were significantly wider at 3 and 6 months after surgery (P < .05). Average absorption values were significantly lower on the PRP side than on the control side at 3 and 6 months after surgery (P < .05). The PRP/control ratio was significantly different at 3 and 6 months compared to that at 2 weeks (P < .005). No adverse events related to PRP occurred with good clinical outcome over 10 years follow-up.Conclusions:Local application of PRP combined with autologous local bone graft has a positive impact on early fusion for lumbar arthrodesis with no adverse events over 10 years, and thus is a safe and low cost autologous option in spinal fusion.

Platelet rich plasma for plantar fasciitis: Is it a hype???

Background: Plantar fasciitis (PF) is the most common cause of heel pain. Platelet-rich plasma (PRP) has recently been demonstrated to be helpful in managing plantar fasciitis. The purpose of this study was to assess the safety & efficacy of PRP in the chronic plantar fasciitis. Materials & Methods: In this study, we included 60 patients with PF of which 30 were given local PRP & other 30 were given steroid and regular follow up was done. Pain intensity and functional outcomes were measured using Visual Analogue Scale (VAS), Ankle-Hind foot Scale (AHFS), Roles-Maudsley Subjective Pain Scale (RMSPS). Patients with PF who had undergone at least 4 weeks of conservative treatment were included whereas patients with history of previous surgery for Plantar Fasciitis, Infection, tumours of lower extremity, Haemorrhagic disorders, on anticoagulant therapy, Pregnancy and Uncontrolled Diabetes were excluded. Results: Both groups were similar in terms of age, gender, side and baseline VAS & AHFS scores. In both the groups, mean VAS scores and the mean AHFS scores improved significantly at the end of one year over the baseline values. Similarly, in both the groups, functional status improved significantly over a period of one year with 73% patients in the steroid group and 97% in the PRP group achieving excellent functional status. The PRP group had significantly higher mean VAS, AHFS and RMSPS scores at 1 year follow-up than the steroid group. (p

Effects of local platelet-rich plasma injection on the rate of orthodontic tooth movement in a rat model: A histomorphometric study

The aims of this study were to determine the effects of different concentrations of platelet-rich plasma (PRP) on alveolar bone density and orthodontic tooth movement. Seventy-six rats were divided into 2 groups: a moderate concentration PRP injection group (n=38) and a high concentration PRP injection group (n=38). In each group, 5 time points were studied: 3, 7, 14, 21, and 60days. Before orthodontic mesialization of the maxillary first molars, moderate and high concentrations of PRP were injected on the right sides of the molar buccal sulcus, and the left sides served as the controls. Tooth movements were measured on 3-dimensional digital models. Alveolar bone volume density and osteoclastic activity in the first molar intraradicular areas were evaluated by histomorphometric analysis. Alveolar bone density was decreased in the experimental groups compared with the control groups (P=0.0001) at 3, 7, 14, and 21days. On day 3, osteoclastic activity of the experimental groups was higher than that of the controls (P=0.044, P=0.0001). On day 21, the amounts of tooth movement in the high-concentration experimental group were 1.7 times greater than in the high-concentration control group and 1.4 times greater than in the moderate-concentration experimental group (P=0.001). On day 60, alveolar bone density increased to the original levels in all groups. Injection of both moderate and high concentrations of PRP may accelerate orthodontic tooth movement by decreasing alveolar bone density on paradental tissues by enhancing osteoclastic activity in a transient way.

Comparison of the early period effects of bone marrow-derived mesenchymal stem cells and platelet-rich plasma on the Achilles tendon ruptures in rats

ABSTRACTIntroduction: This study aims to histopathologically, biomechanically, and immunohistochemically compare the fourth-week efficiencies of local platelet-rich plasma (PRP) and bone marrow-derived mesenchymal stem cell (rBM-MSC) treatments of the Achilles tendon ruptures created surgically in rats. Materials and Methods: The study included 35 12-month-old male Sprague Dawley rats, with an average weight of 400–500 g. Five rats were used as donors for MSC and PRP, and 30 rats were separated into MSC, PRP, and control groups (n = 10). The Achilles tendons of the rats were cut transversely, the MSC from bone marrow was administered to the MSC group, the PRP group received PRP, and the control group received physiological saline to create the same surgical effect. In previous studies, it was shown that this physiological saline does not have any effect on tendon recovery. Thirty days after the treatment, the rats were sacrificed and their Achilles tendons were examined histopathologically, immunohistochemically, and biomechanically. Results: The use of rBM-MSC and PRP in the Achilles tendon ruptures when the tendon is in its weakest phase positively affected the recovery of the tendon in histopathologic, immunohistochemical, and biomechanical manners compared to the control group (p < 0.05). While the levels of pro-inflammatory cytokines TNF-α, IFNγ, and IL 1β were significantly low, the levels of anti-inflammatory cytokines and growth factors playing key roles in tendon recovery, such as IL2, VEGF, transforming growth factor-beta, and HGF, were significantly higher in the MSC group than those of the PRP and control groups (p < 0.05). In the MSC group, the (mm) value was significantly higher (p ˂ 0.05) than that in the PRP and control groups. Conclusion: rBM-MSC and PRP promote the recovery of the tendon and increase its structural strength. The use of PRP and MSC provides hope for the treatment of the Achilles tendon ruptures that limit human beings’ functionalities and quality of life, particularly for athletes. It is thought that the use of MSC can be more effective for tendon healing; hence, more extensive and advanced studies are needed on this topic.

Chronic Plantar Fasciitis: Effect of Platelet-Rich Plasma, Corticosteroid, and Placebo.

Plantar fasciitis is a common cause of heel pain. It is a disabling disease in its chronic form. It is a degenerative tissue condition of the plantar fascia rather than an inflammation. Various treatment options are available, including nonsteroidal anti-inflammatory drugs, corticosteroid injections, orthosis, and physiotherapy. This study compared the effects of local platelet-rich plasma, corticosteroid, and placebo injections in the treatment of chronic plantar fasciitis. In this double-blind study, patients were divided randomly into 3 groups. Local injections of platelet-rich plasma, corticosteroid, or normal saline were given. Patients were assessed with the visual analog scale for pain and with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot score before injection, at 3 weeks, and at 3-month follow-up. Mean visual analog scale score in the platelet-rich plasma and corticosteroid groups decreased from 7.44 and 7.72 preinjection to 2.52 and 3.64 at final follow-up, respectively. Mean AOFAS score in the platelet-rich plasma and corticosteroid groups improved from 51.56 and 55.72 preinjection to 88.24 and 81.32 at final follow-up, respectively. There was a significant improvement in visual analog scale score and AOFAS score in the platelet-rich plasma and corticosteroid groups at 3 weeks and at 3-month follow-up. There was no significant improvement in visual analog scale score or AOFAS score in the placebo group at any stage of the study. The authors concluded that local injection of platelet-rich plasma or corticosteroid is an effective treatment option for chronic plantar fasciitis. Platelet-rich plasma injection is as effective as or more effective than corticosteroid injection in treating chronic plantar fasciitis.

The Effect of Local Platelet Rich Plasma Therapy on the Composition of Bacterial Flora in Chronic Venous Leg Ulcer.

Microbial colonisation of chronic venous ulcers and synergism between bacterial species slow down the healing process. The study aimed at performing qualitative analysis of microbial flora in venous leg ulcers treated with platelet rich plasma (PRP). Twenty two women and twelve men aged 47-90 years were treated with PRP at our department between 2012 and 2015. Ulcer cultures collected before and after PRP therapy yielded 83 and 110 microbial isolates, respectively, of Gram positive, Gram negative bacteria and candida. Pseudomonas aueruginosa and Staphylococcus aureus were the most common pre- and post-treatment isolates. PRP therapy and increased the variety of microbial flora.

Use of Platelet Rich Plasma (PRP) in the Treatment of Acute Post Intubation Tracheal Rupture: Report of Two Cases

The use of PRP involves a complex network of molecular events which accelerate tissue regenera-tion due to its richness in growth factors plus a variety of biologic mediators. Several communica-tions tell us about its usefulness on the dental implantology field, plastic surgery, orthopedics and peripheral nerve regeneration after trauma. We have presented our successful experience of its use in pneumology when treating severe hemoptysis, respiratory fistulae, spontaneous pneumothorax and one tracheal rupture. In this article we present two cases of post intubation tracheal rupture successfully treated with the local instillation of PRP on one of them and with the injection of PRP along the lips of the tracheal wound on the other. Tracheal rupture is a rare but life threatening complication of emergency intubation requiring an effective response in order to avoid the risk of patient death due to secondary mediastinitis and sepsis. Up to now there is no general consensus in the treatment of this condition and alternatives in use are not universally accepted. The use of local autologous PRP in our experience has demonstrated a favorable performance in such cases, turning it in a highly promising tool for the treatment of conditions such as this, in which a rapidly effective and minimally invasive handling is required.

The Efficacy of Platelet Rich Plasma Combined with Steroid Injection in the Treatment of Resistant Lateral Epicondylitis

OBJECTIVE: To evaluate the impact of autologous platelet rich plasma (PRP) combined with steroid injection on hand grip strenght, pain and patient satisfaction in the treatment of lateral epicondylitis.METHODS: 84 patients, mean age 42.6 (23-62) years, diagnosed with unilateral resistant lateral epicondylitis was evaluated retrospectively. Group1 consisted of patients treated with local steroid injection (0,5ml Bethametasone+0.25 ml Prilokain) and PRP within 1 week interval to extensor carpi radialis brevis origo while group 2 consisted of patients who were subjected to single dose local PRP injection to the same localisation. Pretreatment and posttreatment 15-30-60 day hand grip strenght and Verhaar functional score data were evaluated.RESULTS: Mean pretreatment grip strenght of group1 patients were 0.42±0.17 (0.18-0.61) bar whereas posttreatment day 60 increased to 0.68±0.11(0.50-0.85). Group 2 mean pretreatment grip strenght was found to be 0.45±0.15 (0.19-0.84) bar, whereas posttreatment day 60 increased to 0.66±0.10 (0.44-082). Compared to group 2, the percentage of grip strenght increase in group 1 was significantly higher at days 15 and 30, whereas there was no difference at day 60 between groups. (p=0.277). Compared to group 2, Verhaar scores were found to be higher in group1 at days 15 and 30, whereas there was no difference between groups at day 60.CONCLUSION: Compared to PRP alone, steroid injection 1 week prior PRP administration can be preferred as an effective and safe method in cases which early maintanance of decreased grip strenght is mandatory.

Experimental model for the study of the effects of platelet-rich plasma on the early phases of muscle healing.

There is abundant evidence suggesting that growth factors may play a key role in the healing process, especially in the early stages of inflammation. Despite the reported clinical successes with the use of growth factors there is still a lack of knowledge on the biological mechanism underlying the activity of platelet-rich plasma during the process of muscle healing. The aim of this study was to analyse the early effects of platelet- rich plasma in an easily reproducible animal model. Wistar male adult rats (n=102) were used in this study. The muscle lesion was created with a scalpel in the flexor sublimis muscles. Platelet-rich plasma was applied immediately after surgery. Treated, untreated and contralateral muscles were analysed by morphological evaluation and western blot assay. Leucocyte infiltration was significantly greater in muscles treated with platelet-rich plasma than in both untreated and contralateral muscles. The latter showed greater leucocyte infiltration when compared to the untreated muscles. Platelet-rich plasma treatment also modified the cellular composition of the leucocyte infiltration leading to increased expression of CD3, CD8, CD19 and CD68 and to decreased CD4 antigen expression in both platelet-rich plasma treated and contralateral muscles. Blood vessel density and blood vessel diameters were not statistically significantly different between the three groups analysed. The results of this study showed that treatment with platelet-rich plasma magnified the physiological early inflammatory response following a muscle injury, modifying the pattern of cellular recruitment. Local platelet-rich plasma treatment may exert a direct or, more plausibly, indirect systemic effect on healing processes, at least in the earliest inflammatory phase.

Effect of platelet-rich plasma on tendon-to-bone healing after rotator cuff repair in rats: an in vivo experimental study

The purpose of this experimental study was to analyze the effects of local autologous platelet-rich plasma (PRP) injection on tendon-to-bone healing in a rotator cuff repair model in rats. Rotator cuff injury was created in 68 left shoulders of rats. PRP was obtained from the blood of an additional 15 rats. The 68 rats were divided into 4 groups with 17 rats in each group; PRP group (Week 2), control group (Week 2), PRP group (Week 4), and control group (Week 4). Platelet-rich plasma or saline was injected to the repair area intraoperatively. Rats were sacrificed 2 and 4 weeks after the surgery. Histological analysis using a semiquantitative scoring was performed on 7 rats per group. Tendon integrity and increases in vascularity and inflammatory cells and the degree of new bone formation were evaluated and compared between the groups. The remaining tendons (n=10) were mechanically tested. Degree of inflammation and vascularity were less in the study group at both time intervals (p<0.05). Tendon continuity was better in the study group at 2 weeks (p<0.05). Obvious new bone formation was detected in the control group at 4 weeks (p<0.05). Biomechanically, platelet-rich plasma-treated specimens were stronger at 2 weeks (p<0.05). Local autologous PRP injection may have beneficial effects on initial rotator cuff tendon-to-bone healing and enhance initial tendon-to-bone healing remodeling. This may represent a clinically important improvement in rotator cuff repair.

A Systematic Review of the Use of Platelet-Rich Plasma in Sports Medicine as a New Treatment for Tendon and Ligament Injuries

To evaluate, through a systematic review of the current literature, the evidence-based outcomes of the use of platelet-rich plasma (PRP) for the treatment of tendon and ligament injuries. A search of English-language articles was performed in PubMed and EMBASE using keywords "PRP," "platelet plasma," and "platelet concentrate" combined with "tendon" and then "ligament" independently. The search was conducted through September 2010. Search was limited to in vivo studies. Nonhuman studies were excluded. Tissue engineering strategies, which included a combination of PRP with additional cell types (bone marrow), were also excluded. Articles with all levels of evidence were included. Thirteen of 32 retrieved articles respected the inclusion criteria. The authors reviewed and tabulated data according to the year of study and journal, study type and level of evidence, patient demographics, method of PRP preparation, site of application, and outcomes. The selected studies focused on the application of PRP in the treatment of patellar and elbow tendinosis, Achilles tendon injuries, rotator cuff repair, and anterior cruciate ligament (ACL) reconstruction. Seven studies demonstrated favorable outcomes in tendinopathies in terms of improved pain and functional scores. In 3 studies on the use of PRP in ACL reconstruction, no statistically significant differences were seen with regard to clinical outcomes, tunnel widening, and graft integration. One study examined the systemic effects after the local PRP application for patellar and elbow tendinosis. Presently, PRP use in tendon and ligament injuries has several potential advantages, including faster recovery and, possibly, a reduction in recurrence, with no adverse reactions described. However, only 3 randomized clinical trials have been conducted.

The effects of local platelet rich plasma delivery on diabetic fracture healing

Several studies have documented that diabetes impairs bone healing clinically and experimentally. The percutaneous delivery of platelet rich plasma (PRP) was used in the diabetic BB Wistar femur fracture model to investigate the use of PRP as a concentrated source of critical early growth factors on bone healing. PRP delivery at the fracture site normalized the early (cellular proliferation and chondrogenesis) parameters while improving the late (mechanical strength) parameters of diabetic fracture healing. These results suggest a role for PRP in mediating diabetic fracture healing and potentially other high risk fractures.