The Role of Platelet-Rich Plasma in Inducing Musculoskeletal Tissue Healing

Abstract

Background Platelet-rich plasma [PRP] has received increasing interest across many musculoskeletal disciplines and has been widely applied clinically to stimulate tissue healing in numerous anatomical regions. The known actions of platelet-derived factors suggest that PRP may have significant potential in the treatment of pathological conditions of cartilage, tendon, ligament, and muscle. Purpose The aim of this manuscript is to review current literature regarding the biology of PRP and the efficacy of using PRP to augment healing of tendon ligament and muscle injuries, as well as early osteoarthritis. Methods A comprehensive literature review of musculoskeletal applications of PRP was performed, including basic science and clinical studies such as randomized controlled trials, case controlled series, and case series. Results The most compelling evidence to support the efficacy of PRP is for its application to tendon damage associated with lateral and medial epicondylitis. Although some promising studies have been reported supporting the use of PRP in osteoarthritis and ligament and muscle injuries, it currently remains unknown whether PRP effectively alters the progression of osteoarthritis or aids the healing of ligament and muscle tissues. Conclusion The rationale for the use of PRP to improve tissue healing is strong, but the efficacy for many musculoskeletal applications remains unproven. PRP has been shown to be a safe treatment. A number of questions regarding PRP remain unanswered, including the optimal concentration of platelets, what cell types should be present, the ideal frequency of application, or the optimal rehabilitation regimen for tissue repair and return to full function.

Does leukocyte-poor or leukocyte-rich platelet-rich plasma applied with biopolymers have superiority to conventional platelet-rich plasma applications on chondrocyte proliferation?

“…Although animal models are suitable to observe the systemic effects of PRP, animal tissue physiology and sensitivity differ from those of human tissue. [25][26][27] Concerning the small amount of studies demonstrating the in vitro effects of different leukocyte concentrations of PRP, it was observed that these studies are on synoviocytes. [28] or other tissues such as human ligament fibroblasts.…”

“…[28] or other tissues such as human ligament fibroblasts. [26] To the best of our knowledge, in the literature, only one in vitro experimental study tested the effect of PRP on chondrocytes isolated from osteoarthritis tissue. Unfortunately, the cell cultures in this single study were established with tissues isolated only from four male patients.…”

Platelet-rich plasma for muscle injuries: game over or time out?

“…Heightened catabolism is associated with decreased sheer/tensile strength of soft-tissue and has been correlated with decreased recovery and healing. The potential for PRP to augment the negative effects of neutrophils in the initial stage of healing lends support to the recommendation to avoid its use in the first 24 h following muscle injury and/or to use leukocyte-poor PRP preparations [16]. Because neutrophils may exacerbate original muscle damage some have suggested this provides further rationale to consider leukocytepoor PRP for muscle healing [17,18].…”

Ultrasound biomicroscopy and claudication test for in vivo follow-up of muscle repair enhancement based on platelet-rich plasma therapy in a rat model of gastrocnemius laceration

“…PRP contains growth factors and three proteins in blood known to act as a matrix for bone, connective tissue, and epithelial migration 8 . The platelets release various growth factors that stimulate angiogenesis, promote vascular growth and fibroblast proliferation, which increase collagen synthesis 9 .…”

“…The reasons are due to unanswered questions concerning the dosing, timing, and frequency of PRP injections; distinct techniques for delivery and delivery location (over or within the injured tissue site, or intraarticularly); optimal physiologic conditions for injections; and the combined use of recombinant proteins, cytokines, additional growth factors, biological scaffolds, and stems cells 9,10 . Therefore, there is a need to implement more investigations contemplating both aspects of PRP mechanism of action on different types of muscle lesions as well as new forms of diagnostic tools.…”