Platelet-rich plasma therapy - future or trend?

Abstract

Chronic complex musculoskeletal injuries that are slow to heal pose challenges to physicians and researchers alike. Orthobiologics is a relatively newer science that involves application of naturally found materials from biological sources (for example, cell-based therapies), and offers exciting new possibilities to promote and accelerate bone and soft tissue healing. Platelet-rich plasma (PRP) is an orthobiologic that has recently gained popularity as an adjuvant treatment for musculoskeletal injuries. It is a volume of fractionated plasma from the patient's own blood that contains platelet concentrate. The platelets contain alpha granules that are rich in several growth factors, such as platelet-derived growth factor, transforming growth factor-β, insulin-like growth factor, vascular endothelial growth factor and epidermal growth factor, which play key roles in tissue repair mechanisms. PRP has found application in diverse surgical fields to enhance bone and soft-tissue healing by placing supra-physiological concentrations of autologous platelets at the site of tissue damage. The relative ease of preparation, applicability in the clinical setting, favorable safety profile and possible beneficial outcome make PRP a promising therapeutic approach for future regenerative treatments. However, there is a large knowledge gap in our understanding of PRPs mechanism of action, which has raised skepticism regarding its potential efficacy and use. Thus, the aim of this review is to describe the various factors proposed to contribute to the biological activity of PRP, and the published pre-clinical and clinical evidence to support it. Additionally, we describe the current techniques and technology for PRP preparation, and review the present shortcomings of this therapy that will need to be overcome if it is to gain broad acceptance.

Platelet-Rich Plasma Therapies in Lateral Epicondylitis: Are we Asking the Right Questions?

“…Although lateral epicondylitis has been the focus of this editorial, PRP therapies have become widely used for a variety of acute and chronic musculoskeletal injuries [11,12,22]. Lengthy recovery times and residual symptoms, combined with patient demand for an expedited return to activities has increased the popularity of PRP dramatically in the past decade.…”

“…The rationale behind its use lies in its potential ability to provide growth factors to the relatively avascular diseased tendon, thus promoting tissue healing and tendon regeneration [11]. PRP has gained a significant amount of attention in orthopaedic and sports medicine communities in the past decade, largely due to the promising results of pre-clinical laboratory studies [5,11,12]. In practice, PRP is applied by single or multiple injections to the area of maximal tenderness [5].…”

Autologous Platelet Rich Plasma for Neck and Lower Back Pain Secondary to Spinal Disc Herniation: Midterm Results

“…In the musculoskeletal field, although no long-term outcome studies with PRP exist, a large number of patients have been treated worldwide [24][25][26][27]. In our review of the literature we did not come across RCT's that have comprehensively evaluated the safety of PRP treatment [10].…”

“…PRP was a major initial step that led researchers to consider bone marrow aspirates and stem cells in the growing field of orthobiologics [10]. The role of PRP in the directed stimulation of musculoskeletal and mesenchymal stem cells is being widely investigated and shows promise as a short-term use agent that may assist in the simultaneous healing of several musculoskeletal tissues with trauma or elective surgery [6,[14][15][16].…”

“…Platelet-rich plasma is an orthobiologic that has recently gained popularity as an adjuvant treatment for musculoskeletal injuries [10][11][12][13][14][15][16][17][18]. It is a volume of fractionated plasma from the patient's own blood that contains platelet concentrate.…”