The purpose of this review is to develop evidence-based practices for the use of platelet-rich plasma (PRP) to treat osseous pathologies of the lower extremity. There is moderate high-quality evidence to support the efficacy of PRP as a surgical augment to microfracture in osteochondral lesions of the talus (OLT). The literature supports a conceivable positive impact on bony union and osseous healing. There is insufficient evidence to support PRP injections in the conservative management of OLT or symptomatic ankle osteoarthritis. PRP may serve as a viable treatment method in the surgical augmentation of microfracture surgery in OLT and has promise for increasing bony union following surgical operations. Further high-quality, comparative studies with longer clinical follow-up are required.
The preparation methodology for platelet-rich plasma (PRP) may have important clinical implications with varying effectiveness with leukocyte, platelet, and growth factor concentrations.There is high-quality evidence to support the superiority of PRP over corticosteroids in the case of chronic plantar fasciitis.There is moderate-quality to high-quality evidence for PRP's ability to increase tendon thickness with no capacity to decrease pain, increase function, or augment percutaneous tenotomy in Achilles tendinopathy.There is insufficient evidence to support PRP injections in the definitive treatment of Achilles tendon rupture. However, PRP may contribute to postoperative recovery after tendon rupture repair, but this requires further research.The biochemical theory supporting the clinical use of PRP must be reinforced with high-level evidence research. Based on the current literature, PRP may serve as a viable treatment method in chronic plantar fasciitis. Further high-quality, comparative studies with longer clinical follow-up are required to support recommendations for use of PRP in the treatment of Achilles tendon pathology.
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