New and Emerging Strategies in Platelet-Rich Plasma Application in Musculoskeletal Regenerative Procedures: General Overview on Still Open Questions and Outlook

Abstract

Despite its pervasive use, the clinical efficacy of platelet-rich plasma (PRP) therapy and the different mechanisms of action have yet to be established. This overview of the literature is focused on the role of PRP in bone, tendon, cartilage, and ligament tissue regeneration considering basic science literature deriving from in vitro and in vivo studies. Although this work provides evidence that numerous preclinical studies published within the last 10 years showed promising results concerning the application of PRP, many key questions remain unanswered and controversial results have arisen. Additional preclinical studies are needed to define the dosing, timing, and frequency of PRP injections, different techniques for delivery and location of delivery, optimal physiologic conditions for injections, and the concomitant use of recombinant proteins, cytokines, additional growth factors, biological scaffolds, and stems cells to develop optimal treatment protocols that can effectively treat various musculoskeletal conditions.

Cytokine, chemokine, and growth factor profile of platelet-rich plasma

“…However, these effects were dependent on the PRP composition [10]. Somehow data become controversial when in vivo settings are compared, since opposite outcomes are equally available in the scientific literature in favor [11][12][13][14][15][16][17][18][19][20][21] or against [19,[22][23][24][25][26][27] the addition of PRP to biologic and synthetic graft materials for bone regeneration purposes.…”

Optimized Platelet‐Rich Fibrin With the Low‐Speed Concept: Growth Factor Release, Biocompatibility, and Cellular Response

“…Since its introduction in 2001, 1 PRF has been extensively used in dentistry for a variety of procedures, and its effectiveness has been demonstrated for extraction socket management, 8 gingival recessions, 9–11 intrabony defect regeneration, 12 , 13 and sinus elevation procedures 7 . Major advantages include having completely immune‐compatible growth factors collected at relatively no costs without anticoagulants 14–17 . While initial and early experiments revealed PRP contained high concentrations of autologous growth factors (up to 6 to 8 times higher than normal blood concentrations), including platelet‐derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and transforming growth factor (TGF)‐β1, 18 PRF has since been shown to release even higher total growth factors over a more extended period of time 19 …”

Tavşanlarda Mürekkepbalığı Kabuğu ve Kan Pulcuğundan Zengin Plazma ile Birlikte Mürekkep Balığı Kaynaklı Hidroksiapatitin Tibial Kemik Hasarının İyileştirilmesindeki Rolü: Deneysel Bir Çalışma

“…Histopathological examination showed that CBHA could induce new bone formation as a bone substitute in rabbit tibial bone defect. PRP, an inexpensive source rich in growth factors has emerged as an adjuvant therapy that may accelerate regenerative process recently [24][25][26][27] . Numerous experimental studies have applied PRP in association with bone grafts and substitutes; only some were successful [24,27,35] .…”

“…Another biologic source that has widely introduced lately is platelet rich plasma (PRP); defined as a fraction of blood which platelet concentration is above baseline in it. PRP have been applied as an economical angiogenic orthobiologic in association with ceramics such as hydroxyapatite and majority of studies reported promising results; however some found opposite outcome so its regenerative capability is still controversial [24][25][26][27] . The aim of present study was to evaluate in-vivo effectiveness of raw CB and CBHA prepared by hydrothermal synthesis along with PRP in bone repair and to investigate probable synergism between these biomaterials.…”