Platelet-rich Plasma Preparation Methods Research Articles

Platelet-Rich Plasma (PRP) in Hair Restoration Treatments: A Comprehensive Review of Existing Literature

Hair loss is a common concern affecting individuals worldwide. With various therapies available to address this issue, it prompts the search for effective treatments and prevention methods. Platelet-Rich Plasma (PRP) therapy has emerged as a promising option for hair restoration, leveraging the regenerative properties of platelets to stimulate hair growth. This comprehensive review aims to synthesize the existing literature on the use of PRP in hair restoration treatments. A systematic search of major databases was conducted to identify relevant studies evaluating the efficacy and safety of PRP therapy for hair loss of the scalp. Eligible studies were selected based on predetermined inclusion criteria, and data extraction was performed to capture key findings, including patient demographics, PRP preparation methods, treatment protocols, and outcomes measured. The review encompasses both clinical trials and observational studies, providing insights into the effectiveness of PRP therapy in promoting hair regrowth, improving hair density and therefore enhancing patient satisfaction. Additionally, safety considerations, adverse events, and limitations of current evidence are discussed. Overall, this review highlights the growing body of evidence supporting the use of PRP in hair restoration treatments while identifying areas for further research and clinical refinement.

The additive value of platelet-rich plasma to topical Minoxidil in the treatment of androgenetic alopecia: A systematic review and meta-analysis.

It still needs to be determined if platelet-rich plasma (PRP) has any added advantage over Minoxidil in treating androgenetic alopecia. We reviewed randomized controlled trials (RCTs) comparing scalp injections of PRP plus Minoxidil vs Minoxidil alone for managing androgenetic alopecia. All RCTs published on Embase, Cochrane Library, and PubMed comparing PRP plus Minoxidil vs. Minoxidil alone were eligible. The literature search was completed on 5 March 2024. The review was registered on PROSPERO (CRD42024509826). Of five included RCTs, three had a high risk of bias, while one had some concerns. A systematic review of the studies showed that all trials reported better outcomes with PRP plus Minoxidil than with Minoxidil alone. Meta-analysis showed that hair density at one month (MD: 11.07 95% CI: 1.20, 20.94 I2 = 0%), three months (MD: 21.81 95% CI: 10.64, 33.00 I2 = 57%) and 5/6 months (MD: 17.80 95% CI: 7.91, 27.69 I2 = 80%) of follow-up was significantly better in the PRP plus Minoxidil vs the Minoxidil alone group. Meta-analysis of adverse events showed that the risk of adverse events was comparable in both groups (OR: 0.55 95% CI: 0.22, 1.36 I2 = 0%). The certainty of evidence on the GRADE assessment was "low to very low." Very low-quality evidence shows that the addition of injectable PRP to topical Minoxidil may improve outcomes in patients with androgenetic alopecia. The addition of PRP was found to improve hair density and patient satisfaction significantly. However, the small number of studies with a high risk of bias and heterogeneity in PRP preparation methods are significant limitations of current evidence. Further studies with larger sample sizes and uniform PRP preparation protocols are needed.

Systematic Review of Platelet-Rich Plasma in Medical and Surgical Specialties: Quality, Evaluation, Evidence, and Enforcement.

Background: Platelet-rich plasma (PRP) is widely used in various medical and surgical specialties for its regenerative properties, including aesthetics (facial rejuvenation, hair restoration, and skin tightening) and orthopedics (treatment of tendinitis and osteoarthritis). However, the inconsistent literature on PRP's efficacy and safety leads to critical knowledge gaps. This systematic review evaluates quality control measures in PRP preparation and application and explores the regulatory environment governing its clinical use. Methods: Following PRISMA guidelines, a comprehensive search was conducted across multiple databases, including PubMed, EMBASE, and Web of Science, for studies published from January 2020 to April 2024. The review included randomized controlled trials (RCTs) involving human participants undergoing PRP treatment for aesthetic or regenerative purposes. Key parameters such as the PRP preparation methods, platelet concentration, and quality control measures were analyzed. The study protocol was registered with PROSPERO (ID: CRD42024557669). Results: Out of 75 RCTs involving 5726 patients, the review identified significant variability in PRP preparation methods and application techniques, including differences in centrifugation protocols and platelet concentration levels. A new evidence-based scoring system, the William-Eqram Scoring System for PRP Quality Reporting (WESS-PQR), was proposed to address these inconsistencies. Correlation analysis revealed a strong positive correlation (r = 0.79) between proper temperature control during preparation and PRP efficacy. Initial platelet count assessment showed a moderate positive correlation (r = 0.57) with efficacy. Conclusions: Standardized PRP preparation protocols and robust regulatory frameworks are urgently needed to ensure the safety and efficacy of PRP treatments. The proposed WESS-PQR scoring system can serve as a valuable tool for clinicians and researchers, promoting consistency and reliability in PRP applications.

Platelet-Rich Plasma in Aesthetic Dermatology: Current Evidence and Future Directions.

Platelet-rich plasma (PRP) has emerged as a promising treatment in aesthetic dermatology. This systematic review aims to evaluate the current evidence for PRP applications in skin rejuvenation, hair restoration, wound healing, and fat grafting. FollowingPreferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a comprehensive literature search was conducted across multiple databases and 13 studies meeting the inclusion criteria were selected for review. The Mixed Methods Appraisal Tool (MMAT) was used to assess the quality of included studies. The reviewed studies consistently reported positive outcomes for PRP across various applications. In skin rejuvenation, significant improvements in collagen density and overall skin appearance were observed. For hair restoration, studies showed mean increases of 18-27.7 hairs/cm² in treated areas. PRP demonstrated efficacy in accelerating wound healing across various wound types, including chronic ulcers. In fat grafting, PRP was associated with improved graft survival and integration. Patient satisfaction was generally high across all applications. However, there was significant heterogeneity in PRP preparation methods and treatment protocols among studies. This systematic review provides evidence supporting the efficacy of PRP in aesthetic dermatology, particularly in skin rejuvenation, hair restoration, wound healing, and fat grafting. PRP demonstrates a favorable safety profile across applications. However, the variability in study designs and PRP protocols highlights the need for standardization. Future research should focus on large-scale randomized controlled trials with standardized protocols and longer follow-up periods to solidify the evidence base for PRP in aesthetic dermatology.

Impact of Centrifugation Parameters on Platelet-Rich Plasma Injection for Patella Tendinopathy: A Systematic Review and Meta-Analysis.

Patellar tendinopathy (PT) is a chronic, degenerative form of tendinitis commonly affecting young, active individuals. Numerous nonsurgical treatments exist, of which platelet-rich plasma (PRP) is a frontrunner. However, heterogeneity among various PRP preparation techniques results in a large variation in treatment efficacy. This review and meta-analysis aims to investigate the effect of PRP centrifugation factors, specifically centrifuge speed and duration, on functional outcomes in patients with PT. A systematic search of the literature was performed in April 2024 on Medline and Embase. Articles involving the use of PRP in the treatment of PT were included. The risk of bias was assessed using the Risk of Bias 2 (RoB 2; the Cochrane Collaboration, England, UK) and Risk of Bias in Non-randomised Studies of Intervention (ROBINS-I; the Cochrane Collaboration, England, UK) tools. Comparative meta-analysis between the different centrifugation speeds and the different centrifugation durations was performed on articles reporting Victorian Institute of Sports Assessment - Patellar tendon (VISA-P) and visual analogue scale (VAS) scores for PT. Seventeen studies consisting of 360 participants were included in the analysis. The mean follow-up duration was 13.2 months (95% CI: 8.81 to 17.7). The mean VAS reduction was 3.85 (95% CI: -4.63 to -3.08; P < 0.01). VISA-P scores improved by 32.03 (95% CI: 24.29 to 39.78; P < 0.01). There were no significant differences between centrifuge speeds for VAS (P = 0.17) and VISA-P (P = 0.18) and between centrifuge durations for VAS (P = 0.25) and VISA-P (P = 0.27). Centrifuge speed and duration and number of centrifuge cycles did not show any significant differences in patient outcomes. There were no significant differences observed in outcomes for the different preparations of PRP. There remains a need for further high-quality RCTs using standardized PRP preparations with long-term follow-up for the development of a consensus method of PRP preparation for the treatment of PT.

A Comprehensive Review of Platelet-Rich Plasma and Its Emerging Role in Accelerating Bone Healing.

This comprehensive review delves into the emerging role of platelet-rich plasma (PRP) in accelerating bone healing. PRP, a blood-derived product rich in platelets and growth factors, has garnered attention for its regenerative potential. The review begins by defining PRP and providing a historical background, highlighting its significance in expediting bone healing. PRP's composition and preparation methods, including centrifugation techniques and commercial kits, are explored. Mechanistically, PRP operates by releasing growth factors, chemotaxis, and angiogenesis, elucidating its cellular effects. Applications in fracture healing and orthopaedic surgeries, such as joint arthroplasty and spinal fusion, are discussed, emphasising the promising outcomes in clinical trials. Safety considerations, patient selection criteria, and the need for PRP preparation and application standardisation are underscored. The review outlines ongoing research trends, potential technological advancements, and unexplored areas in paediatric applications and inflammatory bone disorders. The implications for clinical practice involve informed decision-making, optimised protocols, and interdisciplinary collaboration. In conclusion, the future of PRP in bone healing holds exciting prospects, with the potential for precision medicine, integration with emerging therapies, expanded applications, and enhanced technological innovations shaping its trajectory in orthopaedics and regenerative medicine.

Platelet-Rich Plasma Applications, The Past 5 Years: A Review Article

Platelet-rich plasma (PRP) is autologous plasma with a platelet concentration that is on average five times greater than baseline, and has been extensively investigated for its potential applications across various medical fields, including orthopaedics, dermatology, wound healing, maxillofacial surgery, and others. This review article aims to provide an overview of PRP’s applications and evidence over the past 5 years in randomised controlled trials. Many studies demonstrate PRP’s effectiveness in reducing pain and improving functional outcomes, while others report no significant differences compared to alternative treatments or placebo. Across various studies, several key limitations exist, such as small sample sizes, short follow-up durations, and lack of standardisation in PRP preparation methods, highlighting the need for research to further establish PRP’s effectiveness in these clinical applications. The article also discusses the different classification systems for PRP, and underscores the importance of understanding the components that influence clinical outcomes, as well as noting the growth of PRP in the marketplace. Overall, while studies exist demonstrating the clinical utility of PRP, standardised reporting is required to determine its full potential, as well as optimal preparation and administration strategies.

Beneficial effects of intraovarian injection of platelet-rich plasma in women with poor ovarian response.

Infertility can result from a diminished ovarian reserve, but a potential remedy exists in the form of platelet-rich plasma (PRP) administration. This treatment involves both biological factors and tissue trauma mechanisms, which stimulate folliculogenesis, making it a promising and effective strategy. We assessed the impact of direct PRP injections into the ovaries on the fertility outcomes of women classified as poor responders. A quasi-experimental study was conducted from April 2021 to December 2022, focusing on patients classified as POSEIDON grade 3 or 4. PRP injections were administered into both ovaries. After 3 months, data were collected on anti-Müllerian hormone (AMH) level, follicle-stimulating hormone (FSH) level, and the numbers of oocytes, mature oocytes, and good-quality embryos following ovarian stimulation. We then compared the data from before and after PRP injection. This study included 50 women, with a mean of 39 years (interquartile range [IQR], 35 to 43) and 4 years (IQR, 2 to 6) for age and infertility duration, respectively. FSH levels decreased after treatment, while AMH levels and the numbers of oocytes, metaphase II oocytes, and high-quality embryos increased. However, only the increase in high-quality embryos was significant. The pregnancy and spontaneous pregnancy rates were 20% and 14%, respectively. Notably, women with secondary infertility exhibited a significantly higher pregnancy rate than those with primary infertility. Ample evidence suggests that PRP can enhance ovarian function. However, further studies are needed to identify the appropriate candidates for this procedure, establish the optimal PRP preparation method, and standardize the procedure for its adjuvant use in assisted reproductive technology cycles.

The use of platelet-rich plasma in osteoarthritis - the current state of knowledge

Introduction and objective: Osteoarthritis (OA) is a chronic condition characterized by progressive damage to the joint cartilage and bone. Platelet-rich plasma (PRP) has gained increasing interest as a potential therapeutic approach for relieving symptoms and improving joint function. The aim of this article is to present the current knowledge regarding the PRP preparation method, mechanisms of action, and treatment outcomes in OA based on scientific literature and recent research. Materials and methods: A review of scientific literature available on Google Scholar, PubMed, and Via Medica journal database was conducted using relevant keywords. State of knowledge: Platelet-rich plasma is obtained from the patient's own blood using differential centrifugation method, resulting in a concentration of platelets (PLT) that is 300-700% higher compared to the baseline. PLTs release various biologically active substances, including growth factors, which stimulate tissue repair and regeneration processes. Numerous studies have shown that PRP administration in patients with osteoarthritis of the knee and hip joints leads to pain reduction and improved joint function. The therapeutic effect yields long-lasting results, lasting up to 12 months after the completion of the treatment. Conclusions: The use of platelet-rich plasma (PRP) in the treatment of osteoarthritis presents a promising alternative to conventional therapies. However, further research is needed to confirm the effectiveness of PRP on a larger sample size and assess the long-term effects of this therapy. Knowledge regarding dosage, treatment protocols, and the duration of therapy remains limited.

Meta-analysis on the Efficacy of Platelet-rich Plasma in Patients with Androgenetic Alopecia.

Platelet-rich plasma (PRP) is an autologous platelet concentrate in plasma enriched with growth factors that may stimulate tissue regeneration, collagen formation, re-epithelization, and angiogenesis. PRP is widely used as an androgenetic alopecia treatment option. The present work aims to test the efficacy of various PRP methods, including those with single-spin and double-spin centrifugation. We performed a review of articles published from 2011 to 2021 in PubMed and ScienceDirect. The studies vary in the preparation procedure, dose, number, intervals between the procedures, and the injection technique because of low standardization of PRP preparation, complicating the evaluation of the clinical efficacy of the method. Based on the conducted statistical analysis, we came to the conclusion that the double-spin PRP preparation method was superior to the single-spin technique, which may be taken into account for AGA management.

Two manual non-commercial preparation methods for platelet-rich plasma in donkeys (Equus asinus)

Platelet-rich plasma (PRP) is a biologic, whole blood (WB) derived, immunomodulatory therapeutic that has gained popularity in brood mares for its potential to mitigate post-breeding uterine inflammation/infection and enhance fertility rates. In jennies, increased susceptibility to post-breeding endometritis and poor fertility rates have been associated with insemination using frozen-thawed jack semen. Because many donkey breeds are threatened with extinction, frozen semen technology offers a viable chance at recovery. Thus, PRP has potential in similarly benefitting donkey breeding programs. However, the majority of PRP protocols previously described in donkeys have not undergone critical assessment. Commercial and noncommercial PRP production methods exist, but the latter confers advantages (e.g., field applicability and decreased cost) for a species more likely to receive veterinary care in resource-limited settings. The objective of this study was to evaluate two manual noncommercial methods of producing PRP (double centrifugation [DC] and single centrifugation [SC]) in six healthy adult donkeys (n=3 jennies; n=3 johns; ages 4-8 years old) undergoing three blood collections two weeks apart. For DC-PRP, WB collected into a 150 mL blood transfusion bag containing citrate-phosphate-dextrose solution with adenine was split into 50 mL tubes, centrifuged at 400 × g/15 min, then plasma transferred into 15 mL conical tubes and centrifuged at 1000 × g/10 min. Afterwards, the bottom 2.5 mL of plasma per tube waspreserved as DC-PRP with the above supernatant as DC platelet-poor plasma (PPP). For SC-PRP, WB was collected into 2.7 mL sodium citrate vacutainer tubes, then centrifuged at 120 × g/10 min. Post-centrifugation, the top third layer of plasma was deemed SC-PPP with the remaining portion as SC-PRP. Concentrations of platelets, leukocytes (WBC), and erythrocytes (RBC), and platelet-derived growth factor-BB (PDGF-BB) were assessed in the WB, and extracted PRP and PPP. Data was analyzed by Friedman and Dunn's as a post hoc test with significance as P<0.05. Both protocols concentrated platelets 1.7–5.2-fold, reduced WBC 1.1–50.4-fold, and decreased RBC at least 829-fold compared to WB (P<0.0001). Activity of PDGF-BB in DC-PRP and SC-PRP increased by 1.2–7.0-fold in comparison to WB (P=0.0003). Platelet concentration and PDGF-BB activity rose 3-fold (P<0.0001) and 5.8-fold (P=0.0007), respectively, in DC-PRP than SC-PRP. Leukocyte concentration was wider in DC-PRP than SC-PRP (P<0.0001), but did not differ between WB and DC-PRP (P=0.61). Reduction in WBC and RBC was 42-fold and 22-fold greater, respectively, in SC-PRP than DC-PRP (P<0.0001). These results indicate that noncommercial methods of PRP preparation described in horses are applicable in donkeys. Double centrifugation yielded higher platelet concentration and PDGF-BB activity despite greater WBC and RBC contamination than PRP processing via SC. Future studies are needed to determine in vivo efficacy of PRP in donkeys.

P17 Platelet-rich plasma as a treatment for vulval lichen sclerosus: a systematic review of safety and efficacy

Abstract Introduction Vulval lichen sclerosus (VLS) is an inflammatory skin disease characterised by pain, itching, burning, apareunia, loss of vulval architecture and scarring. VLS has a significant impact on patients’ quality of life and certain patients find no symptomatic relief in the gold standard treatment of topical corticosteroids. Platelet-rich plasma (PRP) is derived from autologous plasma and injected into disease areas, it may provide superior outcomes for patients than current treatment options. This study systematically reviewed the safety and efficacy of platelet-rich plasma as a treatment for VLS. Methods This review followed PRISMA guidelines using a registered protocol (PROSPERO:CRD42022379894). Multiple databases were searched, along with grey literature on Clinicaltrials.gov, European Union Clinical Trials, and International Standard Randomised Controlled Trial registries. All studies evaluating the safety and/or efficacy of PRP for VLS were included. Results A total of 213 patients were assessed across nine studies. There was significant heterogeneity between studies, in the study design, PRP preparation method and injection volume of plasma used, and outcome measures. Forty-one percent (n=88) of patients reported resolution of symptoms on Quality-of-Life outcome measures or symptom assessment scales, 6% (n=12) patients had histological improvement of inflammation. PRP demonstrated symptom resolution and improvement, however the evidence is insufficient to conclude on its effectiveness or safety, and heterogenous outcome measures preclude pooled data analysis. Conclusion PRP may provide superior results than corticosteroids in certain patients with VLS, however further research is needed to ascertain the safety and efficacy profile of this treatment.

Research progress of platelet-rich plasma in treatment of discogenic low back pain

To summarize the research progress of platelet-rich plasma (PRP) for the treatment of discogenic low back pain (DLBP). The literature on the treatment of DLBP with PRP was extensively reviewed, and the classification, treatment mechanism, in vitro and in vivo experiments and clinical trial progress of PRP were summarized. According to the PRP composition, preparation methods, and physicochemical properties, there are five commonly used PRP classification systems at present. PRP is involved in delaying or reversing the progress of disc degeneration and pain control by promoting the regeneration of nucleus pulposus cells, increasing the synthesis of extracellular matrix, and regulating the internal microenvironment of degenerative intervertebral disc. Although several in vitro and in vivo studies have confirmed that PRP can promote disc regeneration and repair, significantly relieve pain, and even improve the mobility of DLBP patients. But the contrary conclusion has been reached in a few studies, and there are limitations to the application of PRP. Current studies have confirmed the effectiveness and safety of PRP in the treatment of DLBP and intervertebral disc degeneration, as well as the advantages of PRP in terms of ease of extraction and preparation, low immunological rejection, high regenerative and repair capacity, and the ability to compensate for the shortcomings of traditional treatment modalities. However, relevant studies are still needed to further optimize PRP preparation methods, unify systematic classification guidelines, and clarify its long-term effectiveness.

PRPCalc2: An App for Platelet-Rich Plasma Preparation.

Platelet-rich plasma (PRP), an inexpensive yet powerful treatment modality, is widely used but poorly understood. Three areas of unmet need are the ability to compare results using differing centrifuges and methods; translating a study result into a specific practice; and estimating yield and dosage without the benefit of an in-office hematology analyzer. PRPCalc2 is a set of software tools that facilitates these goals. The app consists of software tools that (1) calculate the appropriate radius for centrifugation, (2) calculate the correct revolutions per minute (RPM) for the centrifuge, (3) calculate the mean yield for the method and its confidence interval, and (4) calculate platelet dosage. Using these tools, a practitioner with any centrifuge can create and validate their own PRP preparation method and then use it to create a standardized PRP.

Does Platelet-Rich Plasma Promote Facial Rejuvenation? Revising the Latest Evidence in a Narrative Review.

Facial aging is characterized by progressive macroscopic, histological, and molecular changes. Due to its regenerative and rejuvenating properties, the use of platelet-rich plasma (PRP) as a facial antiaging agent has gained popularity over the last decade. In order to gather and evaluate the latest evidence focusing on the effect of PRP on facial skin rejuvenating, a search through MEDLINE (PubMed) using relevant keywords, inclusion, and exclusion criteria was performed. A total of 539 articles were initially retrieved, and from those, 16 were included in the review. Treatment protocols comprised the use of PRP both in monotherapy and in combination with other substances and by means of direct injection or topical application following skin permeation. The selected studies presented high variability regarding PRP preparation methods, administration protocols, and results assessment. In most studies, PRP seemed to improve to some degree the signs of facial aging, such has wrinkles, skin quality, and pigmentation, accompanied by significant histological and molecular responses. Optimizing treatment protocols should be the next step in assessing the full potential of PRP.

Variability in Platelet-Rich Plasma Preparations Used in Regenerative Medicine: A Comparative Analysis.

Background Platelet-rich plasma (PRP) and its derivatives are used in several aesthetic, dental, and musculoskeletal procedures. Their efficacy is primarily due to the release of various growth factors (GF), interleukins, cytokines, and white blood cells. However, the PRP preparation methods are highly variable, and studies lack consistency in reporting complete procedures to prepare PRP and characterize PRP and its derivatives. Also, all the tissue-specific (in vivo and in vitro) interactions and functional properties of the various derivatives/factors of the PRP have not been taken into consideration by any study so far. This creates a potential space for further standardization of the PRP preparation methods and customization of PRP/PRP derivatives targeted at tissue-specific/pathology specific requirements that would enable efficacious and widely acceptable usage of PRP as main therapy, rather than being used as adjuvant therapy. The main objective of our study was to investigate the variability in PRP preparation methods and to analyze their efficacy and reliability. Method This study considered articles published in the last 5 years, highlighting the variability in their PRP preparation methods and characterization of PRP. Following the PRISMA protocol, we selected 13 articles for the study. The selected articles were assessed using NHLBI quality assessment tool. Results We noted differences in (1) approaches to producing PRP, (2) extent of characterization of PRP, (3) small scale and large-scale preparation methods, (4) in vitro and in vivo studies. Conclusion We identified two studies describing the procedures which are simple, reproducible, economical, provide a good yield of platelets, and therefore can be considered methods for further tissue-specific and pathology-specific standardizations of PRP and its derivatives. We recommend further randomized studies to understand the full therapeutic potential of the constituents of PRP and its derivatives.

The use of platelet-rich plasma in management of musculoskeletal pain: a narrative review.

Musculoskeletal pain is the most common pain reported by patients. Platelet-rich plasma (PRP) is widely used to treat musculoskeletal pain. However, the efficacy of PRP to treat this pain remains controversial. This review highlights the application of PRP in the treatment of musculoskeletal pain. PRP treatment appears to reduce pain and improve function in patients with musculoskeletal pain. However, there are limitations to the currently published studies. These limitations include the PRP preparation methods, type of activators, types of pathology to be treated, methods and times of administration, and association of PRP with other treatments.

Effectiveness of Platelet-Rich Plasma Therapy in Androgenic Alopecia-A Meta-Analysis.

Platelet-rich plasma (PRP) represents a novel therapy tested and is used more and more frequently in dermatology and cosmetic surgery for a variety of conditions, including androgenic alopecia (AGA), a common condition with a complex pathogenesis involving genetic factors, hormonal status and inflammation. We performed an extensive literature search which retrieved 15 clinical trials concerning the use in AGA of PRP therapy, alone or in combination, in male, female or mixed patient groups. A quantitative statistical meta-analysis of n = 17 trial groups proved significant increases in hair density from 141.9 ± 108.2 to 177.5 ± 129.7 hairs/cm2 (mean ± SD) following PRP (p = 0.0004). To the best of our knowledge, this is the first meta-analysis that proved a statistically significant correlation between the number of PRP treatments per month and the percentage change in hair density (r = 0.5, p = 0.03), as well as a negative correlation between the mean age of treatment group and the percentage change in hair density (r = −0.56, p = 0.016). Other factors considered for analysis were the PRP preparation method, amount used per treatment, hair diameter, terminal hairs and pull test. We conclude that PRP represents a valuable and effective therapy for AGA in both males and females if patients are rigorously selected.

The Efficacy of Platelet-Rich Plasma for Ligament Injuries: A Systematic Review of Basic Science Literature With Protocol Quality Assessment.

Background:Despite the existence of many clinical studies on platelet-rich plasma (PRP) interventions for ligamentous pathology, basic science consensus regarding the indications, mechanisms, and optimal composition of PRP for treating ligament injuries is lacking.Purpose:To (1) compare the efficacy of PRP in animal models of ligament injury with placebo and (2) describe the potential variability in PRP preparation using accepted classification systems.Study Design:Systematic review.Methods:The Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, PubMed, Embase, and Ovid MEDLINE were queried in April 2020 for in vivo and in vitro basic science studies regarding PRP use for ligament injury. Study design, results, PRP composition, and analyzed cellular and molecular markers were extracted, and outcomes relative to control models were documented. Bias was assessed using the SYRCLE risk-of-bias tool.Results:Included were 43 articles (31 in vivo and 12 in vitro studies) investigating the anterior cruciate ligament/cranial cruciate ligament (n = 32), medial collateral ligament (n = 6), suspensory ligament (n = 3), patellar ligament (n = 1), and Hock ligament (n = 1). Platelet concentration was reported in 34 studies (77.3%); leukocyte composition, in 12 (27.3%); and red blood cell counts, in 7 (15.9%). With PRP treatment, 5 of 12 in vitro studies demonstrated significant increases in cell viability, 6 of 12 in gene expression, 14 of 32 in vivo studies reported superior ligament repair via histological evaluation, and 13 in vivo studies reported superior mechanical properties. Variability in PRP preparation methods was observed across all articles, and only 1 study reported all necessary information to be classified by the 4 schemes we used to evaluate reporting. Among the in vivo studies, detection and performance bias were consistently high, whereas selection, attrition, reporting, and other biases were consistently low.Conclusion:Conflicting data on the cellular and molecular effects of PRP for ligament injuries were observed secondary to the finding that included studies were heterogeneous, limiting interpretation across studies and the ability to draw meaningful conclusions. Clinical trials and any causal relationship between PRP use in ligament injuries and its potential for regeneration and healing should be pursued with caution if based solely on basic science data.

A Split Scalp Study of Single versus Double Spin Platelet-rich plasma Injections in Treatment of Female Pattern Hair Loss: Clinical Effect and Relation to Vascular Endothelial Growth Factor in PRP

Abstract Background Female pattern hair loss (FPHL) is the most common hair loss disorder in women. Platelet-rich plasma (PRP) provides an option for patients recalcitrant to the currently approved therapies. As there are many methods for the preparation of PRP, the most suitable for AGA therapy is not yet clear. Aims To compare the efficacy between single and double spin PRP injections in treatment of FPHL and to assess the relationship between the concentrations of vascular endothelial growth factor (VEGF) in the PRP preparation and the treatment results obtained. Patients and Methods 15 female patients with FPHL were enrolled. Each patient was subjected to intradermal injection of PRP (prepared by double-spin method) into the right half of the scalp, in addition to intradermal injection of PRP (prepared by singlespin method) into the left half of the scalp in the form of three treatment sessions three weeks apart. Evaluation of treatment response was done through comparing patients' global photographs, assessment of patients' satisfaction and folliscopic assessment before and after treatment. Results Our results showed clinically significant improvement by comparing patients' photographs in most of the treated patients. In addition, folliscopy revealed significant change of the terminal hair density in the right half of the scalp following treatment sessions.VEGF concentration didn't differ significantly between double-spin and single-spin prepared PRP, also it didn't differ significantly upon calcium activation. Conclusions PRP is an effective treatment modality for FPHL. Double-spin prepared PRP could yield better results in the treatment of FPHL than the single-spin method. However, adding Calcium gluconate prior to PRP injection is of no benefit as it didn't significantly increase the release of VEGF. Yet, further studies discussing different PRP preparation protocols and involving a larger number of cases are needed to minimize statistical errors and to detect the most accurate PRP preparation method with the greatest yield of growth factors.