Platelet-rich Plasma Group Research Articles

33. COMPARATIVE PILOT STUDY OF SURGICAL ACTIVATION VS APPLICATION OF PLATELET-RICH PLASMA ON OVARIAN FUNCTION IN AN OVINE ANIMAL MODEL

Abstract Introduction Premature ovarian failure is one of the main problems presented by women with fertility problems. This pathology is characterized by a low ovarian reserve or by the presence of quiescent follicles that for unknown reasons have not been activated and have not been able to carry out their recruitment and subsequent maturation. Recent studies suggest the activation of follicles in a quiescent state capable of being rescued and activated for their function as a possible therapeutic route. Based on this hypothesis, the objective of our study was to verify whether through surgical activation and/or the use of platelet-rich plasma (PRP) these quiescent follicles could be “activated” and reactivate folliculogenesis. For this, and taking into account the similarity between the human and ovine ovary, we used the sheep as an animal model for study. Methods To carry out this study, we started with 6 sheep that we divided into 2 groups: group 1 (n=3) surgical activation through small cuts in the ovarian cortex; group 2 (n=3) activation by injection into the ovary of PRP, both interventions in the right ovary leaving the left as control (Figure 1). To evaluate the effect of these two techniques on folliculogenesis, oophorectomies were performed at 2, 4, and 6 months, the ovaries were histologically analysed, and blood samples were taken every 15 days to measure hormones involved in folliculogenesis and ovarian reserve (AMH, FSH, Progesterone and estradiol). Results The results obtained in the histological analysis (Figure 2) indicate that after the injection of PRP the highest percentage of primary follicles is obtained 4 months after its injection, beginning to decrease from this moment, while in the case after surgical activation, the percentage of primary follicles gradually increases until reaching its highest percentage at 6 months. Regarding follicular growth, in the case of PRP the highest percentage of growth is obtained at 6 months and in the case of surgical activation at 2 months and then gradually decreases. When evaluating the levels of hormones in the serum of the different groups at different times (Figure 3), we found that in the case of progesterone, the highest levels are achieved after 2 months in both groups, with the values ​​being higher for the group of PRP than surgical activation. For estradiol, the highest levels are obtained at 2 and 6 months, with the levels for the PRP group always being higher, in a similar way occurs with AMH, although there are no differences between the maximum values ​​of the two groups. In the case of FSH, its levels begin to increase until the 4th month, where maximum levels are reached in both groups. Conclusion In general we can say that both treatments produce an increase in the number of follicles and their development and an increase in the levels of hormones related to follicular activity and ovarian reserve, although it is not clear which of the two treatments is better.

Does the Combination of Platelet-rich Plasma and Supervised Exercise Yield Better Pain Relief and Enhanced Function in Knee Osteoarthritis? A Randomized Controlled Trial.

Knee osteoarthritis is a leading cause of disability with substantial healthcare costs, and efficient nonsurgical treatment methods are still needed. Platelet-rich plasma (PRP) injections and exercise therapy are used frequently in clinical practice. Whether PRP or PRP combined with exercise is more effective than exercise alone is unclear. (1) Which treatment relieves knee osteoarthritis pain better: PRP alone, exercise, or PRP combined with exercise? (2) Does PRP alone, exercise, or PRP combined with exercise yield better results in terms of the WOMAC score, performance on the 40-m fast-paced walk test and stair climbing test, and the SF-12 health-related quality of life score? In this randomized, controlled, three-arm clinical trial, we recruited patients with mild-to-moderate (Kellgren-Lawrence Grade II or III) knee osteoarthritis with a minimum of 3 points on the 11-point numeric rating scale for pain. During the study period, 157 patients with a diagnosis of knee osteoarthritis were screened and 84 eligible volunteers were enrolled in the study. Patients were randomly allocated (1:1:1) into either the exercise group (28), PRP group (28), or PRP + exercise group (28). Follow-up proportions were similar between the groups (exercise: 89% [25], PRP: 86% [24], PRP + exercise: 89% [25]; p = 0.79). All patients were analyzed in an intention-to-treat manner. There were no between-group differences in age, gender, arthritis severity, and baseline clinical scores (pain, WOMAC, functional performance tests, and health-related quality of life). The exercise group underwent a 6-week structured program consisting of 12 supervised individual sessions focused on strengthening and functional exercises. Meanwhile, the PRP group received three weekly injections of fresh, leukocyte-poor PRP. The PRP + exercise group received a combined treatment with both interventions. The primary outcome was knee pain over 24 weeks, measured on an 11-point numeric rating scale for pain (ranging from 0 to 10, where 0 represents no pain and 10 represents the worst pain, with a minimum clinically important difference [MCID] of 2). The secondary outcome measures included the WOMAC index (ranging from 0 to 100, with lower scores indicating a lower level of disability and an MCID of 12), the durations of the 40-meter fast-paced walk test and stair climbing test, and the SF-12 health-related quality of life score. For the a priori sample size calculation, we used the numeric rating scale score for pain at 24 weeks as the primary outcome variable. The MCID for the numeric rating scale was deemed to be 2 points, with an estimated standard deviation of 2.4. Based on sample size calculations, a sample of 24 patients per group would provide 80% power to detect an effect of this size between the groups at the significance level of p = 0.05. We found no clinically important differences in improvements in pain-defined as ≥ 2 points of 10-at 24 weeks when comparing exercise alone to PRP alone to PRP + exercise (1.9 ± 0.7 versus 3.8 ± 1.8 versus 1.4 ± 0.6; mean difference between PRP + exercise group and exercise group -0.5 [95% confidence interval -1.2 to 0.4]; p = 0.69). Likewise, we found no differences in WOMAC scores at 24 weeks of follow-up when comparing exercise alone to PRP alone to PRP + exercise (10 ± 9 versus 26 ± 20 versus 7 ± 6; mean difference between PRP + exercise group and exercise group -3 [95% CI -12 to -5]; p = 0.97). There were no differences in any of the other secondary outcome metrics among the PRP + exercise and exercise groups. PRP did not improve pain at 24 weeks of follow-up in patients with mild-to-moderate knee osteoarthritis compared with exercise alone. Moreover, exercise alone was clinically superior to PRP alone, considering function and the physical component of health-related quality of life. Despite the additional costs and endeavors related to PRP products, the combination of PRP and exercise did not differ from exercise alone. The results of this randomized controlled trial do not support the use of PRP injections in the treatment of patients diagnosed with mild-to-moderate knee osteoarthritis. Consequently, exercise alone is the recommended treatment for reducing pain and enhancing function throughout this timeframe. Level I, therapeutic study.

Effectiveness of Autologous Platelet-Rich Plasma Therapy in Women with Repeated Implantation Failure: A Randomized Clinical Trial.

Platelet-rich plasma (PRP) therapy has been shown to enhance tissue regeneration by expressing several cytokines and growth factors (GFs). This study investigated the effect of intrauterine infusion of PRP as a noninvasive autologous GF on pregnancy outcomes in women with repeated implantation failure. This randomized clinical trial was conducted to compare the pregnancy rates between two groups of women who were candidates for the frozen-thawed embryo transfer with a history of two or more implantation failures. The PRP group (n=33) was treated with hormone replacement therapy+0.5 cc to 1 cc PRP infused into the uterine cavity two days before the embryo transfer. The control group (n=33) was only treated with hormone replacement therapy. The endometrial preparation process was done similarly in both groups. The chemical, clinical, and ongoing pregnancy, and implantation rates were compared between the two groups. Our results showed that the chemical pregnancy rate was not statistically higher in the PRP group in comparison with the control group (36.4 vs. 24.2%). In addition, the clinical pregnancy, ongoing pregnancy, and implantation rates were higher in the PRP group than the control group; however, the difference between the two groups was not statistically significant. Administration of intrauterine PRP before embryo transfer in women with repeated implantation failure (RIF) does not affect assisted reproductive technology (ART) outcomes (registration number: IRCT2016090728950N3).

Exploring the Association Between Age Groups and Success Patterns in Platelet-Rich Plasma Therapy: A Cohort Study.

Objective This study aimed to comprehensively examine the correlation between success trends in platelet-rich plasma (PRP) therapy and the advancing age of patients undergoing fertility interventions. Methods Female participants were categorized randomly into five age groups undergoing PRP or conventional hormone replacement therapy. Procedures included controlled ovarian stimulation, escalating estrogen dosage, gonadotrophin injections, and embryo transfer post-ovulation trigger. A pivotal PRP intervention was provided to half of the age sub-groups, and endometrial thickness was assessed 24 hours prior to embryo transfer. Statistical analysis employed SPSS 26.0 for Windows Student Version (IBM Inc., Armonk, New York), incorporating descriptive statistics, one-way analysis of variance (ANOVA), Tukey's honestly significant difference (HSD) testto explore age-PRP success relationships (p<0.05). Results The study, involving 60 participants, revealed a balanced patient distribution across age groups, with 20-30 age groups contributing 23.33% each. Baseline characteristics showed no significant differences between PRP and hormone replacement therapy (HRT) groups. Post-intervention, PRP demonstrated consistently higher endometrial thickness (p<0.001) and clinical pregnancy rates (63.33%) compared to HRT (40%). These findings suggest a positive association between PRP therapy and improved outcomes, particularly in younger age cohorts. Conclusion The study challenges traditional perspectives on hormonal influences in fertility, highlighting a potential link between PRP therapy and favorable outcomes among younger age groups. Improved endometrial thickness and clinical pregnancy rates in the PRP group emphasize the need for further exploration of PRP's mechanisms and applications in reproductive medicine.

Comparison of the Photofunctionalization and Platelet-Rich Plasma in the Immediate Implants

ABSTRACT Introduction: Many adjuvant methods have been researched to enhance the immediate implant success in the recent times. The study’s goal was to compare the aesthetic and biological results of immediate dental implants in the aesthetic zone to standard tapered root form implants that had not undergone pre-treatment with platelet-rich plasma or photofunctionalization. Materials and Methods: The study used a randomized controlled trial as its design. Ninety subjects were chosen at random and placed into three groups: a control group, a case group, and a group that needed replacement of their maxillary anterior teeth right away following extraction. The interventional groups received the “Platelet-Rich Plasma (PRP)” or “Photofunctionalization (PF)” group before the implant placement. After the delayed loading approach, the prosthesis was given after 6 months. At the second and fourth weeks, as well as 2, 4, 6, and 12 months (P 0.05), follow-up was conducted. The success and survival rate, aesthetic, and biological outcomes were assessed. One-way ANOVA was used to compare outcomes, and repeated-measures ANOVA was used to assess intragroup variations over baseline and follow-up. Results: The distal, mesial, and mean marginal bone loss as well as the aesthetic scores for pink and white did not differ significantly between groups. The implant stability however was significantly higher in the PF and PRP groups as compared to the controls. A single implant failed in all the three groups. The success percentage was similar for all the groups. Conclusion: The stability of immediate dental implants pre-treated with PRP or PF differed statistically significantly than the subjects in the control group, while other parameters remained the similar between the groups.

The role of platelet-rich plasma in androgenetic alopecia: A systematic review.

Androgenetic alopecia (AGA), also referred to as male or female pattern hair loss, is the commonest cause of chronic hair loss and affects up to 80% of men by the age of 70. Despite a high prevalence, there are few approved therapies, which show minimal efficacy. This systematic review aims to evaluate the efficacy of platelet-rich plasma (PrP) in the treatment of AGA in male patients. MEDLINE, EMBASE, Cochrane (CENTRAL), CINAHL, clinicaltrials.gov, Google Scholar and the Science Citation Index database were searched to identify eligible studies. All randomized controlled trials (RCTs) and prospective cohort studies related to PrP use in AGA were included. Primary outcomes included changes in hair density and hair count. Methodological quality was assessed using bias assessment tools. EightRCTs and one cohort study were included in the review with a total of 291 participants. Six studies reported a statistically significant increase in hair density in the PrP group versus the control. Five studies reported a statistically significant increase in hair count with PrP. Seven studies showed moderate risk and two showed lowrisk of bias. In a methodologically robust review on the effectiveness of PrP on male AGA, PrP demonstrated some potential to be used therapeutically. However, the low quality of evidence, moderate risk of bias, and high heterogeneity of included studies limit inferences and call for more robust designs to investigate this further.

Addressing radiotherapy-induced fibrosis: the potential of platelet-rich plasma and infliximab for improved breast cancer management.

Breast cancer treatment encompasses various therapeutic modalities, including surgery, radiotherapy, and chemotherapy. Breast-conserving surgery has been an integral part of breast cancer management. However, radiotherapy, an important component of breast cancer management, can lead to complications, particularly fibrosis, affecting reconstructive surgery outcomes. We conducted an in vivo study using 48 female Wistar Albino rats, employing segmental mastectomy and radiotherapy to simulate post-mastectomy conditions. The rats were divided into six groups: control, mastectomy, mastectomy + radiotherapy, mastectomy + platelet-rich plasma (PRP) + radiotherapy, mastectomy + infliximab + radiotherapy, and mastectomy + infliximab + PRP + radiotherapy. Edema, hyperemia, inflammation, and fibrosis were assessed as indicators of tissue response. Histopathological analysis revealed that mastectomy + infliximab and mastectomy + infliximab + PRP groups showed significant reductions in fibrosis compared to other groups. Edema, hyperemia, and inflammation were also less severe in these groups compared to the control group. Radiotherapy-induced fibrosis is a major concern in breast reconstruction. Our study suggests that local PRP application and systemic infliximab administration, either alone or in combination, could mitigate the adverse effects of radiotherapy. This approach has the potential to improve reconstructive outcomes in patients undergoing or having the possibility to undergo radiotherapy. This is the first study showing the effectiveness of infliximab and PRP combination on wound healing. The provided experimental rat model might offer guidance for further research. This study provides insights into optimizing outcomes in reconstructive breast surgery, paving the way for further research and clinical studies.

Efficacy and Safety of Platelet-Rich Plasma for Pressure Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Pressure ulcers are common chronic wounds in clinical practice, severely affecting patients' quality of life and causing substantial economic burdens. Platelet-rich plasma (PRP) has been explored for its potential in treating pressure ulcers. Herein, a study was carried out to evaluate the efficacy and safety of PRP in comparison to conventional treatments for pressure ulcers. A comprehensive search was conducted in databases including PubMed, Embase, Web of Science, and Cochrane Library, covering studies published from the inception to May 20, 2023, with only randomized controlled trials (RCTs) assessing the effect of PRP on the healing of pressure ulcers included. The outcomes of interest included healing rates, ulcer area, ulcer volume, Pressure Ulcer Scale for Healing (PUSH) score, healing time, and complications. Finally, 9 RCTs, involving 511 patients with 523 pressure ulcers, met the inclusion criteria. Our meta-analysis revealed a significant improvement in the healing rate, as evidenced by a weighted odds ratio (OR) of 3.40 (95% CI = 1.87 to 6.21, I2 = 32%, P < 0.0001). Additionally, the standard mean difference (SMD) for healed ulcer area favored the PRP group, reflecting an improvement of 1.38 cm2 (P = 0.02). Furthermore, the reduction in PUSH scores within the PRP group outperformed that observed in the control group, demonstrating a SMD of 1.69 (P = 0.01). Nevertheless, complications and the SMD for ulcer volume reduction revealed no statistically significant differences between the groups. From these findings, PRP stands out as a promising and safe therapeutic approach for pressure ulcers. For a deeper understanding of PRP's role in pressure ulcer healing, it is crucial to conduct more well-structured, high-quality RCTs in upcoming studies.

Assessing the Efficacy of Laser Therapy and Autologous Platelet-Rich Plasma (PRP) Treatment for Chronic Wounds.

(1) Background: The management of persistent wounds is a topic of significant concern, particularly when they become chronic. Clinicians are focused on reducing the healing duration of chronic wounds and employing the most efficient treatments. Successful wound management requires an understanding of standard healing processes, the elements that can impede healing progress, and strategies to manage these impediments. (2) Methods: We participated in a study involving a cohort of 115 patients. Data were collected through subjective assessments via questionnaires, examining the comparative effects of laser therapy and platelet-rich plasma (PRP) on patients' conditions and monitored the progression of chronic wounds. For the study, we utilized a branded laser equipped with a 12-watt probe to stimulate chronic wounds in 65 patients, while the PRP procedure was administered to 50 patients. (3) Results: We observed a greater improvement in local symptoms among the patients who received laser therapy compared to those in the PRP group. (4) Conclusions: We consider both therapies to be of significant importance due to their positive and beneficial effects, particularly on the symptomatology and progression of chronic wounds. Nevertheless, superior results were documented in patients who underwent laser therapy.

Comparative Study of Efficacy of Corticosteroid Versus Analogues PRP in Chronic Plantar Fasciitis in Andhra Pradesh Population

Background: Plantar fasciitis is a common pathological condition of the foot and can be a challenge for cliniciansto treat successfully.Method: Out of 60 patients 30 patients were injected corticosteroid 2ml (8 mg) along with 0.5ml of plain 2% xylocaineusing 20G wide bore needle. PRP (platelet rich plasma) was prepared from the autologous blood, drawnfromcubital vein three BD vacutainer tubes which is 2.7 ml tube that contains 0.35 ml of 3.2% of sodium citrate as an anticoagulant. Blood was centrifuged twice, first time at 1200/rpm, second time 2400 rpm. The platelets were checkedrandomly by pathologist by Neubauer’s chamber method or auto analyser. PRP was injected at tenderness site,after injecting 2% of xylocaine with 20 Gauze needle and follow-up was done for a week, 6th week, 3rd month and6thmonths and outcomes of results were noted.Results: Clinical manifestations were VAS Baseline score – 7.137 in PRP group, 7.214 was in steroid group. Baselineof AOFAS was 53 (SD±5.12) in PRP group, 54.6 (SD±3.30) in steroid group. VAS score at 6th week was 2.62 in PRPgroup, 1.94 in steroid, at 3rd month 1.94 in PRP, 2.89 in steroid group, at 6th month 1.42 in PRP and 3.79 in steroidgroup. AOFAS scores was highly significant (p&lt;0.001) at 6th weeks, 3rd months and 6th months.Conclusion: Corticosteroid therapy is more effective for short duration relief but PRP therapy is more effectivefor long term relief.

Effect of bone marrow aspiration concentrate and platelet-rich plasma combination in anterior cruciate ligament reconstruction: a randomized, prospective, double-blinded study

BackgroundThe effect of bone marrow aspirate concentrate (BMAC) and platelet-rich plasma (PRP) combination in enhancing graft maturation and tendon–bone tunnel interfacial healing after anterior cruciate ligament (ACL) reconstruction remains unclear. We hypothesised that BMAC and PRP combination could lead to better clinical results and better graft maturation/interface healing than PRP alone or conventional ACL reconstruction without any other biologic augmentation.MethodsIn this randomised double-blind prospective study, patients undergoing ACL reconstruction surgery were randomly assigned into three groups: (1) control group (without any biologic augmentation), (2) PRP treatment group, and (3) combined BMAC and PRP (BMAC + PRP) group. Moreover, they were evaluated using the clinical functional score, laxity examination, and magnetic resonance imaging (MRI) analysis.ResultsNo significant difference was observed in the improvement of functional scores among groups. However, laxity improvement at 24 weeks showed a significant difference with the BMAC + PRP group having the lowest laxity. MRI analysis showed no significant change in whole graft maturation among groups. In particular, the BMAC + PRP group showed delayed signal peak and higher graft signal at 24 weeks compared with the other two groups; however, the difference was not significant. With regard to tendon–bone interfacial healing, the BMAC + PRP group showed significantly wider tendon–bone interface in the femoral bone tunnel at 24 weeks compared with the other two groups. Moreover, the BMAC + PRP group showed significantly higher peri-tunnel edema signal in the femoral bone tunnel at 12 weeks compared with the other two groups.ConclusionPRP alone and BMAC and PRP combination showed limited enhancing effect in clinical function, graft maturation and tendon–bone interfacial healing compared with control (no additional treatment). When BMAC is used in ACL reconstruction, the possibility of greater inflammation in the early stage to graft maturation and bone tunnel healing should be considered.

Comparative evaluation of platelet-rich plasma, autologous blood serum, and umbilical cord serum for corneal healing after penetrating keratoplasty in New Zealand rabbits

This study aimed to evaluate the effects of platelet-rich plasma (PRP), autologous blood serum (ABS), and umbilical cord serum (UCS) on corneal healing following penetrating keratoplasty (PK). A total of 120 New Zealand white rabbits, forty were designated as donors, while the remaining eighty rabbits were randomly divided into four groups after undergoing PRP Group (n = 20), ABS Group (n = 20), UCS Group (n = 20) and Control Group (n = 20). Corneal opacity score, corneal vascularization, corneal staining, histopathological analysis, and immunohistochemical analysis (including CD4+, CD8+, and major histocompatibility complex [MHC] II) were assessed at postoperative 1, 2, 3, and 12 weeks. The results showed that corneal opacity score and corneal vascularization did not differ significantly among the groups. However, corneal staining was found to be statistically higher in the PRP group (0.40 ± 0.60) compared to the other groups (p = 0.011). Immunohistochemical examination revealed no significant differences in CD4+, CD8+, and MHC II levels among the groups. Notably, in all groups, CD4+, CD8+, and MHC II levels were significantly higher at 12 weeks compared to other time points. PRP, ABS, and UCS demonstrated positive effects on corneal healing after PK. However, among the three products, PRP exhibited a superior healing effect compared to ABS and UCS crucial in the postoperative period following PK procedures, as they significantly impact visual quality, graft transparency, graft survival, and prevention of stromal resorption caused by infections. Despite the avascular nature of the cornea and its immune privilege, failure to resolve epithelial defects (ED) commonly observed after PK can result in irreversible scarring and ulceration, leading to graft rejection. While epithelial defects are observed in 14–100% of cases on the first postoperative day, approximately 3–7% of them persist as non-healing ED in subsequent periods. In conclusion, our study demonstrated that PRP, ABS, and UCS have a positive effect on corneal healing after PK.

Therapeutic effect of computed tomography-guided dorsal root ganglion pulsed radiofrequency regulation combined with platelet-rich plasma injection on postherpetic neuralgia: A retrospective study.

Postherpetic neuralgia (PHN) is one of the common refractory neuropathic pains. Oral drug treatment has great side effects and poor efficacy. To study the efficacy of computed tomography (CT)-guided pulsed radiofrequency (PRF) targeting dorsal root ganglion (DRG) and platelet-rich plasma (PRP), this retrospective observation was performed. All patients with PHN were divided into the control group, PRF group, and PRF + PRP group based on their different treatment methods. The control group (45 cases) received drug treatment, the PRF group (45 cases) received CT-guided PRF treatment targeted to DRG, and the PRF + PRP group received PRF and PRP treatment. The changes of the numeric rating scale (NRS), Pittsburgh sleep quality index (PSQI) levels, and short form 36 health survey questionnaire (SF-36) before treatment and 7 days, 14 days, 30 days, and 90 days after treatment were compared among three groups. NRS and PSQI scores in the PRF + PRP group were lower than those in the PRF group and control group at 90 days after treatment ( p < 0.001). At 90 days after the operation, the scores of SF-36 in the PRF + PRP group were obviously elevated compared with the data of the control group and PRF group ( p < 0.001). The pain degree, quality of sleep of patients, and quality of life with PHN were significantly improved after PRF combined with PRP treatments.

Efficacy of platelet-rich plasma in alleviating split skin graft morbidities.

Skin grafting is a routinely employed technique to cover the skin defect. Though the skin grafts are technically effortless, they are tiresome because of the prolonged duration of hospital stay, labor-intensive, demanding repeated dressings, and also create a second wound. Platelet-rich plasma (PRP) is one that has a higher concentration of platelets than the blood. Alpha granules of the platelets are rich in growth factors. To assess the effect of PRP on split-thickness skin graft uptake and donor site healing. In a single-center-based prospective study done from August 2018 to June 2020, 60 patients with acute and chronic wounds were divided into two equal groups. Autologous PRP was applied on the recipient wound bed and donor site in PRP group, and conventional methods like staples/sutures were used to anchor the skin grafts and standard of care of the donor site in a control group. Instantaneous graft adhesion was observed in all patients of PRP group. The first graft inspection was delayed. Seroma, hematoma, total number of dressings, and duration of stay in hospital were significantly reduced in the PRP group. Donor site pain in the postoperative period was notably reduced in PRP group. PRP also remarkably hastened the donor site healing. The application of PRP promotes graft take, minimizes complications, enhances donor site wound healing, mitigates donor site pain, and has immense economic benefits due to the reduced number of dressing changes and shorter hospital stay.

Platelet rich plasma could replace tranexemic acid in total knee replacement? A comparative study between their postoperative- bleeding hemostatic effects

Background: The aim of the study is to detect whether platelet rich plasma (PRP) is equal to tranexemic acid (TXA) in reducing blood loss and transfusion rates following total knee arthroplasty (TKA), and compare clinical outcomes, complications, and cost effectiveness between the two groups. This is one of the first randomized, controlled trials that compare both materials in elective knee arthroplasty. Methods: 120 patients were randomized. Postoperative blood loss was determined and compared by measuring the total drainage suction together with the hemoglobin level and blood transfusion rate. Thromboembolic complications and knee society score were recorded. Results: The mean total drain output was 469 mL in the TXA group compared with 698 mL in the PRP group, with statistical significance. There were significant differences in reduction of hemoglobin level (TXA: 1.21 vs. PRP: 2.08). The rate of deep vein thrombosis (DVT) in patients given TXA was higher than those given PRP, however, there were no significant differences. No transfusions were required in either group, and no significant differences were found in the length of hospital stay, pain assessment and knee society score. Conclusions: Though the blood loss was significantly bigger in the custom-made PRP group, no transfusions were required. Meanwhile, the rate of DVT in the PRP group tends to be lower than those in TXA group. We concluded that PRP was not superior to TXA in reducing perioperative blood loss, however further large-scale randomized trials are crucial to confirm these results to be added to the calling literature.

The application of platelet-rich plasma during laparotomy in patients with gynaecological malignancies improves wound healing and reduces postoperative pain feeling - a single-blind placebo controlled intervention study (preliminary report).

This study was aimed to evaluate the impact of platelet-rich-plasma (PRP) application into the wound during laparotomy in gynaecological cancer patients on wound healing and postoperative pain. Forty-six patients undergoing surgical treatment due to gynaecological malignancies were included in this single-blind placebo-controlled intervention study: 23 women in the PRP group and 23 patients in the placebo group. Postoperative pain was assessed by using the visual analogue scale immediately after surgery, and 6 and 12 hours after the surgery. The use of analgesics after surgery was also recorded. The postoperative scar was assessed by patient and clinician using the patient and observer scar assessment scale (POSAS). Wound dehiscence was diagnosed in 1 (4.3%) patient in the PRP group and 4 (17.4%) women in the control group (p = 0.346). After adjustment, the risk of wound dehiscence after PRP application was significantly lower in comparison to the control group (odds ratio - OR, 0.17; 95% CI: 0.03-0.92; p = 0.040). The risk of reporting more intense pain associated with PRP treatment 12 hours after surgery was significantly reduced (OR 0.25; 95% CI: 0.07-0.83; p = 0.023). Platelet-rich-plasma patients required fewer total morphine doses than the control group (8.22 ±3.3 vs. 10.96 ±5.05; p = 0.048). Significant differences between the groups in the scar quality assessment were also detected on the basis of POSAS scale on days 8, 30, and 90 after surgery. Platelet-rich-plasma application during abdominal closure in gynaecological cancer patients may improve wound healing, as well as reduce pain and the use of analgesics in the early postoperative period.

Comparative study on the efficacy of PRP gel and UC-MSCs gel as adjuvant therapies in the treatment of DFU wounds.

Diabetic foot ulcer (DFU) is a common and serious complication of diabetes, and its treatment is challenging. Platelet-rich plasma (PRP) gel and umbilical cord mesenchymal stem cells (UC-MSCs) gel have been concerned as new therapies for DFU in recent years, and comparative studies on the efficacy and mechanisms of these methods, however, are rarely reported. Thirty patients with DFU were selected and divided into the PRP group and the UC-MSCs group, and wound healing, foot blood vessels (ABI index), infection index (CRP), neuropathy symptoms (TCSS score), and foot skin temperature before and after treatment were compared between the two groups. SPSS 21.0 was used for statistical analysis. The results showed that the efficacy of the UC-MSCs gel group was significantly better than that of the PRP group in terms of wound healing rate, time to complete wound closure, ABI index, CRP level and TCSS score. No statistically significant difference in foot skin temperature was observed between the two groups. The efficacy of UC-MSCs gel is significantly superior to that of PRP gel in the treatment of DFU, with shortened time to complete wound closure, increased wound healing rate, better pain and infection control, and improved vascular and neurological symptoms.

The role of platelet rich plasma enriched fat graft for correction of deformities after conservative breast surgery.

Fat transfer has been widely used after breast conservative surgery (BCS) where it aims to recover shapes as a simple, inexpensive, biocompatible method but the technique is not without complications. Platelet Rich Plasma (PRP) is a promising approach to enhance fat graft survival and subsequently improve the outcome. The aim of this study was to evaluate the effect of enriching fat graft with PRP for delayed correction of deformities after conservative surgery for breast cancer regarding esthetic outcome and incidence of complications. The current study included 50 female patients who were scheduled for delayed lipofilling for correction of deformities after conservative surgery for breast cancer. The studied patients were randomly allocated into 2 groups: Group I (G I) included 25 patients scheduled for PRP enriched lipoinjection and Group II (G II) included 25 patients scheduled for lipoinjection without PRP as a control group. Number of sessions of lipoinjection was significantly less in G I in comparison to G II (P =0.024). During the 2nd session; the amounts of fat injected and harvested were significantly less in G I in comparison to G II (P =0.049 and 0.001 respectively). Recipient site complications were significantly more evident in G II in comparison to G I (P =0.01). Surgeon and patient satisfactions were significantly more evident in GI in comparison to G II (P =0.005 and 0.029 respectively). The addition of PRP to fat grafts is a simple, cost-effective and safe method to improve esthetic outcome and decrease complications.

Heterotopic Ossification and Platelet-Rich Plasma in Core Muscle Injuries: A Single-Institution Experience Over 6 Years

Background: A 2015 study of platelet-rich plasma (PRP) for groin injuries in National Football League (NFL) players alerted the authors to the possibility that PRP is associated with heterotopic ossification (HO). The current study of athletes seen between 2014 and 2019 provides a more comprehensive analysis of that observation. Purpose/Hypothesis: This report describes the early results of groin surgery for athletes who had experienced failed PRP therapy performed by different practitioners and with an assortment of PRP techniques. The primary goal of this cohort study was to determine short-term clinical outcomes after surgery of PRP-treated patients. It was hypothesized that previous PRP treatment would be associated with the presence of HO among patients with core muscle injuries (CMIs). Study Design: Cohort study; Level of evidence, 3. Methods: All athletes seen at 1 institution and identified at their first visit as having received PRP for a CMI were followed and compared with patients with a CMI who had not previously received PRP. Although in many cases HO was observed on clinical examination or imaging, HO was identified intraoperatively in all surgical cases and confirmed pathologically. Successful surgery was defined as return to play at previously high levels of performance or greater as determined by the athletes’ own assessments. All patients who had received PRP were followed for ≥2 years. Results: Among 3642 patients with a new CMI seen between 2014 and 2019, 68 (1.9%) patients developed HO within the core muscles and/or adjacent soft tissues. Of the 68 patients, 60 (88.2%) were men, and the mean age was 34.5 years. Of the 68 patients, 62 (91.2%) were athletes and 44 (64.7%) had been treated previously with PRP. HO was observed in 24 (0.7%) patients without previous PRP treatment. Three athletes who received PRP retired early from sports because of HO and scar issues. In total, 22 of 28 (78.6%) NFL players who received PRP developed HO, compared with 0 (0%) of 28 randomly selected, age-, position-, and injury-matched NFL players. After surgical repair, 3-month success rates were 67.9% and 96.4%, respectively, in the PRP and non-PRP groups (P = .006). By 6 months postoperatively, PRP-treated patients were back to similarly high success rates compared with the non-PRP cohort. Scar tissue issues played a prominent role in the relative delay in definitive success. Conclusion: The present, more comprehensive study confirms the previous preliminary analysis that treating CMIs with PRP may be associated with HO.

Clinical efficacy of mesenchymal stem cells and platelet-rich plasma in the therapy of osteoarthritis: a meta-analysis.

Intra-articular administration of mesenchymal stem cells (MSCs) presents a novel methodology for managing osteoarthritis, but there is still no definite evidence of its efficacy. To assess the comparative effectiveness of MSCs and platelet-rich plasma (PRP) for managing osteoarthritis by reviewing the literature and using meta-analysis. Randomized controlled trials and cohort studies comparing MSCs and PRP for managing osteoarthritis were included. We searched 'osteoarthritis', 'mesenchymal stem cell', 'platelet-rich plasma', and other words in Pubmed, Embase, and Cochrane Library database. The search period encompassed the entire duration of the databases, starting from its inception until April 2024. Two researchers conducted the literature search, extracting data, and evaluating quality as distinct processes. Meta-analysis was carried out using the software RevMan5.3, and the calculation of weighted mean difference (WMD) and 95% confidence interval (CI) were performed using either a fixed-effect model or a random-effects model. Eleven studies were included, comprising 8 randomized controlled trials and 3 cohort studies. A total of 693 individuals participated in the study, of which 394 received intra-articular injections of MSCs (group A) and 299 received intra-articular injections of PRP (group B). The two groups were comparable in the five dimensions of knee injury and osteoarthritis outcome score (KOOS) [pain (WMD: 0.38, 95% CI: -3.62 to 4.38, P > 0.05), symptoms (WMD: -1.48, 95% CI: -5.90 to 2.94, P > 0.05), activities of daily living (ADL, WMD: -2.36, 95% CI: -6.87 to 2.14, P > 0.05), function in sport and recreation (Sport/Rec, WMD: -3.84, 95% CI: -10.60 to 2.92, P > 0.05), knee-related quality of life (QOL, WMD: 0.09, 95% CI: -5.48 to 5.67, P > 0.05)] and Western Ontario and McMaster Universities osteoarthritis index (WOMAC, WMD: 0.47, 95% CI: -3.76 to 4.70, P > 0.05). Compared with group A, the International Knee Documentation Committee Subjective Knee Form (IKDC, WMD: 4.19, 95% CI: 2.57 to 5.82, P < 0.001) score of group B was higher. The short-term effectiveness of intra-articular administration of PRP for managing osteoarthritis is slightly better than that of MSCs. However, because of the limited quantity of incorporated research studies and the potential for bias, requisite in the future are studies of substantial size and superior quality.