Platelet-Rich Plasma Treatment for Ligament and Tendon Injuries

Abstract

Platelet-rich plasma (PRP) is derived from centrifuging whole blood, has a platelet concentration higher than that of the whole blood, is the cellular component of plasma that settles after centrifugation, and contains numerous growth factors. There is increasing interest in the sports medicine and athletic community about providing endogenous growth factors directly to the injury site, using autologous blood products such as PRP, to potentially facilitate healing and earlier return to sport after musculoskeletal injury. Despite this interest, and apparent widespread use, there is a lack of high-level evidence regarding randomized clinical trials assessing the efficacy of PRP in treating ligament and tendon injuries. Basic science and animal studies and small case series reports on PRP injections for ligament or tendon injuries, but few randomized controlled clinical trials have assessed the efficacy of PRP injections and none have demonstrated scientific evidence of efficacy. Scientific studies should be performed to assess clinical indications, efficacy, and safety of PRP, and this will require appropriately powered randomized controlled trials with adequate and validated clinical and functional outcome measures and sound statistical analysis. Other aspects of PRP use that need to be determined are (1) volume of injection/application, (2) most effective preparation, (3) buffering/activation, (4) injection technique (1 depot vs multiple depots), (5) timing of injection to injury, (6) single application versus series of injections, and (7) the most effective rehabilitation protocol to use after PRP injection. With all proposed treatments, the doctor and the patient should weigh up potential benefits of treatment, potential risks, and costs. Based on the limited publications to date and theoretical considerations, the potential risks involved with PRP are fortunately very low. However, benefits remain unproven to date, particularly when comparing PRP with other injections for ligament and tendon injuries.

Bilateral platelet rich plasma injections with assisted techniques for temporomandibular joint disorders

“…Potential complications following the procedures are mild; therefore, this method of treatment appears to be safer in comparision with surgical techniques [4]. PRP injection applied by orthopaedic surgeons and sport medicine physicians to the knee, ankle, and elbow joints [11,12]. New studies suggest that PRP injection might be beneficial for TMJ ligament and cartilage healing [4].…”

The Effects of Platelet-Rich-Plasma (PRP) Injection on Ligament Injury

“…6 Some studies have demonstrated that increased cellularity during early wound healing may have a positive impact on ligament and tendon; 7 however, other studies have found no such relationship. 8 This creates a problem in which physicians are unsure whether the treatment of PRP is justified.…”

“…1, 6 The actions of both of these growth factors can be seen with the improved work of fibroblasts on the treated group.…”

Platelet-Rich Plasma Injections In The Management Of Chronic Tendinopathies

“…3 On the other hand, autologous blood, PRP and autologous conditioned serum deliver growth factors to the diseased areas to stimulate the repair process. [4][5][6] Platelet-rich plasma (PRP) is defined as a sample of autologous blood with concentrations of platelets above baseline values. 26 Platelets play an instrumental role in the normal healing response via the local secretion of growth factors and recruitment of reparative cells.…”