Does platelet-rich plasma enhance microfracture treatment for chronic focal chondral defects? An in-vivo study performed in a rat model

Hapa, Onur; Çakıcı, Hüsamettin; Yüksel, Halil Yalçın; Fırat, Tülin; Kükner, Aysel; Aygün, Hayati

doi:10.3944/aott.2013.2928

Cited by 22 publications

(16 citation statements)

References 30 publications

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“…Several trials have reported superior functional outcome and improved histologic scores when comparing PRPenhanced microfracture versus microfracture alone. 10,11 Data regarding outcomes of BioCartilage use in human subjects are limited to expert opinion, but controlled human trials examining outcome differences between standard microfracture and BioCartilage techniques are currently under way. To date, an overall beneficial effect has been observed in more than 1,000 patients implanted with BioCartilage, with no adverse events related to this therapy.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Glenoid Chondral Defect Using Micronized Allogeneic Cartilage Matrix Implantation

Shin

Mellano

Cvetanovich

et al. 2014

Arthroscopy Techniques

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Focal chondral lesions of the glenohumeral joint, though less common than chondral defects in the knee or ankle, can be a significant source of pain in an active population. For patients in whom nonsurgical management fails, promising results have been reported after arthroscopic microfracture surgery to treat such lesions. However, microfracture leads to growth of fibrocartilage tissue and is biomechanically less durable than native hyaline cartilage. Recently, augmentation of the microfractured defect with micronized allogeneic cartilage and platelet-rich plasma has been described to restore hyaline-like cartilage and potentially protect the subchondral bone from postsurgical fracture biology within the base of the defect. We present a simple arthroscopic technique of implanting dehydrated, micronized allogeneic cartilage scaffold to treat an isolated chondral lesion of the glenoid.

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Section: Discussionmentioning

confidence: 99%

Treatment of Glenoid Chondral Defect Using Micronized Allogeneic Cartilage Matrix Implantation

Shin

Mellano

Cvetanovich

et al. 2014

Arthroscopy Techniques

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“…To preserve the advantages of chondrocyte therapy in a single-stage approach to osteochondral defects, Marmotti and coworkers [ 123 ] offered a single-step therapeutic approach for osteochondral defects using autologous cartilage fragments loaded onto a scaffold composed of a hyaluronic acid derivative, human fibrin glue, and PRP, in a rabbit model. Finally, the same studies [ 124 , 125 ] using sheep and rats, evaluated the effect of PRP combined with microfractures on healing of chondral defects, showing that PRP application in addition to microfractures resulted in a better cartilage healing than microfractures alone.…”

Section: The Role Of Prp In the Regeneration Of Cartilagementioning

confidence: 99%

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

Salamanna

Veronesi

Maglio

et al. 2015

BioMed Research International

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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.

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“…1,24,32,48 Preclinical in vivo studies are in line with these findings, reporting the beneficial role of PRP when applied after microfracture surgery. 14,29,30 Milano et al 30 reported that PRP had positive effects on cartilage repair and restoration after microfracture in chronic chondral defects in a sheep model, with better histological properties compared with controls, although the procedure was more effective when PRP was placed surgically on the defect as a fibrin glue gel in comparison with a liquid intra-articular injection. Milano et al 29 further investigated the postoperative injection approach by analyzing the effect of a multiple injection cycle; in this study on the treatment of knee focal chondral defect in sheep, 5 weekly injections of PRP after microfracture led to significantly better macroscopic, histological, and biomechanical results than the results in the control group treated with microfracture only.…”

Section: Discussionmentioning

confidence: 99%

Platelet-Rich Plasma Augmentation to Microfracture Provides a Limited Benefit for the Treatment of Cartilage Lesions: A Meta-analysis

Boffa

Previtali

Altamura

et al. 2020

Orthopaedic Journal of Sports Medicine

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Background: Microfracture is the most common first-line option for the treatment of small chondral lesions, although increasing evidence shows that the clinical benefit of microfracture decreases over time. Platelet-rich plasma (PRP) has been suggested as an effective biological augmentation to improve clinical outcomes after microfracture. Purpose: To evaluate the clinical evidence regarding the application of PRP, documenting safety and efficacy of this augmentation technique to improve microfracture for the treatment of cartilage lesions. Study Design: Systematic review; Level of evidence, 3. Methods: A systematic review was performed in PubMed, EBSCOhost database, and the Cochrane Library to identify comparative studies evaluating the clinical efficacy of PRP augmentation to microfracture. A meta-analysis was performed on articles that reported results for visual analog scale (VAS) for pain, International Knee Documentation Committee (IKDC), and American Orthopaedic Foot and Ankle Society (AOFAS) scores. Risk of bias was documented through use of the Cochrane Collaboration Risk of Bias 2.0 and Risk of Bias in Non-randomized Studies of Interventions assessment tools. The quality assessment was performed according to the Grading of Recommendations Assessment, Development and Evaluation guidelines. Results: A total of 7 studies met the inclusion criteria and were included in the meta-analysis: 4 randomized controlled trials, 2 prospective comparative studies, and 1 retrospective comparative study, for a total of 234 patients. Of the 7 studies included, 4 studies evaluated the effects of PRP treatment in the knee, and 3 studies evaluated effects in the ankle. The analysis of all scores showed a difference favoring PRP treatment in knees (VAS, P = .002 and P < .001 at 12 and 24 months, respectively; IKDC, P < .001 at both follow-up points) and ankles (both VAS and AOFAS, P < .001 at 12 months). The improvement offered by PRP did not reach the minimal clinically important difference (MCID). Conclusion: PRP provided an improvement to microfracture in knees and ankles at short-term follow-up. However, this improvement did not reach the MCID, and thus it was not clinically perceivable by the patients. Moreover, the overall low evidence and the paucity of high-level studies indicate further research is needed to confirm the potential of PRP augmentation to microfracture for the treatment of cartilage lesions.

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Does platelet-rich plasma enhance microfracture treatment for chronic focal chondral defects? An in-vivo study performed in a rat model

Abstract: The addition of PRP application to microfracture treatment appears to enhance cartilage healing in chronic focal chondral defects.

Cited by 22 publications

References 30 publications

Treatment of Glenoid Chondral Defect Using Micronized Allogeneic Cartilage Matrix Implantation

Treatment of Glenoid Chondral Defect Using Micronized Allogeneic Cartilage Matrix Implantation

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

Platelet-Rich Plasma Augmentation to Microfracture Provides a Limited Benefit for the Treatment of Cartilage Lesions: A Meta-analysis

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