Corticosteroids and Local Anesthetics Decrease Positive Effects of Platelet-Rich Plasma: An In Vitro Study on Human Tendon Cells

Carofino, Bradley C.; Chowaniec, David M.; McCarthy, Mary Beth; Bradley, James P.; Delaronde, Steve; Beitzel, Knut; Cote, Mark P.; Arciero, Robert A.; Mazzocca, Augustus D.

doi:10.1016/j.arthro.2011.09.013

Cited by 130 publications

(114 citation statements)

References 36 publications

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“…All subjects followed the same rehabilitation protocol. Limitations of this study included that post-procedure analgesic medications included ketoprofen, and this may have blunted the therapeutic efficacy of the PRP [35]. Additionally, the surgeon performing the procedures was not blinded to the two treatment groups.…”

Section: Patellar Tendonmentioning

confidence: 99%

“…They also had a single practitioner who had 15 years of experience and had performed 20,000 ultrasound guided injections perform all the injections. Limitations of this study include that the tendon was bathed in bupivacaine in both treatment groups, as this can potentially decrease the therapeutic effect [35]. Also, the performing physician was not blinded to the procedure.…”

Section: Evidence Regarding Use Of Prp For Tendinopathymentioning

confidence: 99%

“…They reported that glucocorticoid was more effective than PRP and saline in both reducing color Doppler activity as well as reducing tendon thickness. Limitations of this study include that a local anesthetic was used in the peritendon, and this may have decreased the therapeutic effect of the PRP [35]. The authors describe that the initial primary outcome measure was going to be the PRTEE at 12 months post-procedure.…”

Section: Evidence Regarding Use Of Prp For Tendinopathymentioning

confidence: 99%

“…The primary outcome measure, DASH, was a validated upper limb functional score. Limitations of this study include that the PRP was combined with a local anesthetic, which may inhibit some of the beneficial effects of the PRP [35]. Additionally, prior to the procedure, subjects had been treated with cast immobilization, a steroid injection, or physiotherapy.…”

Section: Evidence Regarding Use Of Prp For Tendinopathymentioning

confidence: 99%

“…The limitations of this study include the lack of a randomized control group, and the small number of patients. The tendon also had a small amount of bupivacaine injected, which can theoretically decrease the efficacy of PRP [35]. It is also important to note that 140 patients were initially evaluated, and only 15 % were enrolled in the study.…”

Section: Evidence Regarding Use Of Prp For Tendinopathymentioning

confidence: 99%

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PRP: review of the current evidence for musculoskeletal conditions

Malanga

Goldin

2014

Curr Phys Med Rehabil Rep

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Injection of platelet-rich plasma (PRP) is an evolving treatment option for various musculoskeletal injuries. There is basic scientific evidence that suggests that the various growth factors present in PRP can help to augment the body's natural healing. There are also clinical studies suggesting efficacy for several conditions, particularly tendinopathy and osteoarthritis. This article reviews the definition and first uses of PRP, the basic scientific rationale for its use, and the basic science and evidence for its use in the treatment of tendon, joint, ligament, and muscle injuries. There are varying levels of evidence for and against the use of PRP for these types of injuries, and this article reviews studies that support as well as studies that refute the use of this new treatment. There are several studies that have assessed the basic science supportive of PRP treatments, as well as the clinical efficacy of this treatment in vivo. While the current evidence is mixed, several recent studies have demonstrated therapeutic benefit in the treatment of various tendinopathies and degenerative joint diseases of the knee. There are several factors that need to be addressed to elucidate whether PRP is truly effective. These include fully defining the PRP mixture (e.g. concentration, growth factor levels, presence of white cells and red cells, etc.), determining the optimal preparation and delivery of the PRP graft, calculating the appropriate number of injections for each specific pathologic process, and defining optimal post-procedure rehabilitation.

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Section: Patellar Tendonmentioning

confidence: 99%

Section: Evidence Regarding Use Of Prp For Tendinopathymentioning

confidence: 99%

Section: Evidence Regarding Use Of Prp For Tendinopathymentioning

confidence: 99%

Section: Evidence Regarding Use Of Prp For Tendinopathymentioning

confidence: 99%

Section: Evidence Regarding Use Of Prp For Tendinopathymentioning

confidence: 99%

See 3 more Smart Citations

PRP: review of the current evidence for musculoskeletal conditions

Malanga

Goldin

2014

Curr Phys Med Rehabil Rep

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Platelet-Rich Plasma Injection vs Sham Injection and Tendon Dysfunction in Patients With Chronic Midportion Achilles Tendinopathy

Malanga

Mautner

Buford³

2021

JAMA

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Effect of local anesthetics on platelet physiology and function

Dregalla¹,

Uribe²,

Bodor

2021

Journal Orthopaedic Research

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Local anesthetics are often used at the site of injury or mixed with platelet‐rich plasma to reduce pain when treating orthopedic and sports‐related injuries. Local anesthetics have been shown to have deleterious effects on stromal cells, but their impact on platelets has not been investigated. In this study, we aimed to assess the effects of lidocaine, bupivacaine, and ropivacaine on platelet health. Based on the deleterious effects of local anesthetics on nucleated cells, we hypothesized that these compounds would affect platelet viability, intracellular physiology, and function. Platelet preparations were derived from randomly selected donors and exposed to lidocaine 1%, bupivacaine 0.75%, ropivacaine 0.5%, and saline at 1:1 and 1:3 ratios. Platelet morphology, viability, intracellular calcium, production of radical oxygen species (ROS), apoptosis, and adhesion were assessed via fluorescent microscopy and flow cytometry. Bupivacaine resulted in increased ROS production, calcium dysregulation, apoptosis, and reduced platelet adhesion. By contrast, ropivacaine and lidocaine were similar to saline in most assays, except for a low degree of mitochondrial stress as evidenced by increased ROS production. Ultimately, bupivacaine 0.75% was harmful to platelets as evidenced by reduced platelet viability, adhesion, and increased apoptosis, whereas lidocaine 1% and ropivacaine 0.5% were relatively safe at the 1:1 and 1:3 dilutions. Clinical significance: Lidocaine 1% and ropivacaine 0.5% can be used at up to a 1:1 ratio with platelet preparations to reduce the pain and discomfort of PRP procedures while maintaining platelet therapeutic potential.

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Corticosteroids and Local Anesthetics Decrease Positive Effects of Platelet-Rich Plasma: An In Vitro Study on Human Tendon Cells

Cited by 130 publications

References 36 publications

PRP: review of the current evidence for musculoskeletal conditions

PRP: review of the current evidence for musculoskeletal conditions

Platelet-Rich Plasma Injection vs Sham Injection and Tendon Dysfunction in Patients With Chronic Midportion Achilles Tendinopathy

Effect of local anesthetics on platelet physiology and function

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