Efficacy of Autologous Platelet-Rich Plasma Use for Orthopaedic Indications: A Meta-Analysis

Abstract

"Platelet Rich Plasma" (PRP) is a ubiquitous term for a type of therapy that applies autologous platelets collected from whole blood and then concentrated via centrifuge that are reapplied to injured musculoskeletal tissue. The intent of most PRP therapies is to locally create or support a "healing response," that instigates earlier healing, or to initiate a response in chronic degenerative and painful tissue. Complicating research efforts are the high number of different types and methods of PRP therapies, and the multiple anatomic and tissue sites of treatment that may potentially benefit from PRP. One of the greatest challenges in the development of PRP therapy have been translating promising laboratory and animal study results to clinical studies' outcomes. While enthusiasm for PRP therapy has often exceeded the evidence to support therapeutic benefits, recent studies and experience does support the use of specific types of PRP therapy in specific degenerative and injury patterns.

Cochrane in CORR ®: Platelet-rich Therapies for Musculoskeletal Soft Tissue Injuries (Review)

“…Short-term improvements in pain were identified but the effect sizes were small, and unlikely to be clinically important. These results are similar to other recent systematic reviews and meta-analyses on this subject [9]. This review of best available evidence adds to our understanding that PRP use for musculoskeletal soft tissue injuries is currently unsupported.…”

“…The diagnosis and management of such injuries represent a substantial financial burden, estimated at more than USD 15.8 billion annually [6]. The use of autologous blood concentrates, particularly platelet-rich plasma (PRP), has exponentially grown as a result of significant media attention and use among high-level athletes [9]. While originally used to manage dermatologic and oromaxillofacial conditions, musculoskeletal applications related to bone and soft tissue injury have become widespread [9].…”

“…The use of autologous blood concentrates, particularly platelet-rich plasma (PRP), has exponentially grown as a result of significant media attention and use among high-level athletes [9]. While originally used to manage dermatologic and oromaxillofacial conditions, musculoskeletal applications related to bone and soft tissue injury have become widespread [9]. The market for PRP was valued at USD 45 million in 2009 and is expected to be worth more than USD 120 million by 2016 [7].…”

The effect of platelet-rich plasma on osteochondral defects treated with mosaicplasty

“…In addition, although many positive results have been reported, there have also been unpredictable results, due to variable platelet concentrations in solutions and different preparation techniques [9,40,41,42]. Nevertheless, in a very recent review by Sheth et al, they attributed uncertain results for orthopaedic indications to a lack of standardization of outcome measures, PRP production, and investigative protocols [42,43]. In order to overcome these limitations and standardize the preparation of PRP, we used the same manufacturer's kits; thus, we avoided creating a misleading factor, and we achieved an increase of at least four to five times over baseline platelet numbers, which was suggested as a sufficient cellular response by Marx [44].…”

Updates in biological therapies for knee injuries: bone

“…Clinical data is still controversial and based on case series where PRP is used either alone or associated with bone grafts or bone substitutes [37,38]. To date, there is no evidence sustaining the use of PRP as a supporting aid in bone regeneration [39][40][41].…”