Current Clinical Recommendations for Use of Platelet-Rich Plasma

Abstract

Purpose of Review This review evaluates current clinical literature on the use of platelet-rich plasma (PRP), including leukocyterich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP), in order to develop evidence-based recommendations for various musculoskeletal indications. Recent Findings Abundant high-quality evidence supports the use of LR-PRP injection for lateral epicondylitis and LP-PRP for osteoarthritis of the knee. Moderate high-quality evidence supports the use of LR-PRP injection for patellar tendinopathy and of PRP injection for plantar fasciitis and donor site pain in patellar tendon graft BTB ACL reconstruction. There is insufficient evidence to routinely recommend PRP for rotator cuff tendinopathy, osteoarthritis of the hip, or high ankle sprains. Current evidence demonstrates a lack of efficacy of PRP for Achilles tendinopathy, muscle injuries, acute fracture or nonunion, surgical augmentation in rotator cuff repair, Achilles tendon repair, and ACL reconstruction. Summary PRP is a promising treatment for some musculoskeletal diseases; however, evidence of its efficacy has been highly variable depending on the specific indication. Additional high-quality clinical trials with longer follow-up will be critical in shaping our perspective of this treatment option.

Platelet-rich Plasma: Three Decades and Ongoing, Do We Have a Conclusion?

“…In another randomized controlled trial, treatment of patients with chronic lateral epicondylitis with PRP reduced pain and increased function significantly, exceeding the effect of corticosteroid injection even after a follow-up of 2 years (21) . There is high-quality evidence supports the use of leucocyte poor-PRP injections for osteoarthritis of the knee (17) . However, the clinical application of PRP in hip arthritis, rotator cuff tendinopathy, bone repair and high ankle sprains remains controversial with insufficient evidence (7,17) .…”

“…There is high-quality evidence supports the use of leucocyte poor-PRP injections for osteoarthritis of the knee (17) . However, the clinical application of PRP in hip arthritis, rotator cuff tendinopathy, bone repair and high ankle sprains remains controversial with insufficient evidence (7,17) . On the other hand, many randomized trials found no effect of PRP on Achilles tendinopathies (22)(23)(24) .…”

“…PRP injections have been investigated in hip and knee osteoarthritis, ankle sprains, healing of non-united fractures, tennis elbow, chronic refractory patellar tendi-nopathy, plantar fasciitis and sports injuries in many clinical studies (17)(18)(19) . A prospective randomized controlled study concluded that local application of autologous PRP improved tendon healing in patients undergoing arthroscopic rotator cuff repair and reduced pain in the first postoperative months (20) .…”

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“…Tennis Elbow [35] Hamstring [68] Knee [47] Extensor digitorum longus [50] Ankle [27] Gastrocnemius [56] Carpal Tunnel [65] Rotator Cuff [54] Tibialis Anterior [21] [52] ▶Fig. 1 Illustration shows clinical and pre-clinical evidence for the beneficial effects of platelet-based applications on different areas of the body for tendon, ligament and skeletal muscle regeneration.…”

“…This microenvironment may be potentially harmful in already existing cancers; however, platelet-based applications are argued to be autologous and non-harmful as they do not induce mutagenesis [64]. On the other hand, clinical trials report an effective and safe outcome to using platelet-based applications for multiple treatments with no observed side effects [15,17,41,50,65]. Additionally, allogeneic platelet-rich plasma has recently been deemed safe for osteoarthritis patients according to a human pilot study [66].…”