How Effective are Injections of Platelet-Rich Plasma (PRP) for the Treatment of Sports Injuries: a Critical Review of the Literature

Abstract

Acute soft-tissue lesions and chronic overuse injuries in the sports medicine field are very frequent and in most cases, difficult to treat. Tissue repair in musculoskeletal lesions is often too slow and sometimes incomplete for a given athlete. The fastest, most complete recovery is of primary importance, and keeping the delay until return-tofield as brief as possible, a priority. Many bioactive proteins and growth factors amongst others influence healing processes. Administration of Platelet Rich Plasma enables the production, from the patient's own blood, of natural, high concentrations of autologous growth factors. Basic research and animal studies are promising, but evidencebased studies examining the treatment of human musculoskeletal lesions by Platelet Rich Plasma are still lacking. Nevertheless, such treatment is increasingly used in sports medicine clinical practice and much is expected of growth factor injections. The aim of this non exhaustive review is to analyze the existing literature published in the fields of sports medicine. The results of this analysis do not permit us to recommend the systematic and generalized use of Platelet Rich Plasma injections in the management of sport injuries. Nevertheless, a few promising results have to be mentioned, but high-quality studies are needed to provide scientific evidence about these injections' effectiveness.

Effects of intra-articular administration of hyaluronic acid or platelet-rich plasma as a complementary treatment to arthroscopy in horses with osteochondritis dissecans

“…However, when the joint presents an associated inflammatory process, the chondrocytes fail in this response in relation to insulin-like growth factor 1, and present an unconventional response to transforming growth factor β. Platelets have growth factors such as transforming growth factor β (TGF-β), insulin-like growth factor 1 (IGF-1), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF), epidermal growth factor (EGF) and platelet-derived epidermal growth factor (PDEGF). These growth factors promote increased gene transcription, proliferation and cell differentiation ( Ziltener et al., 2012 ). It is hypothesized that these growth factors contained in PRP may contribute to the regeneration of articular cartilage, since TGF-β increases the phenotypic expression of chondrocytes, chondrogenic differentiation of mesenchymal stem cells, disposition of extracellular matrix, in addition to decreasing suppressive effects of the inflammatory mediator interleukin 1 on proteoglycan synthesis in cartilage.…”

“…It is hypothesized that these growth factors contained in PRP may contribute to the regeneration of articular cartilage, since TGF-β increases the phenotypic expression of chondrocytes, chondrogenic differentiation of mesenchymal stem cells, disposition of extracellular matrix, in addition to decreasing suppressive effects of the inflammatory mediator interleukin 1 on proteoglycan synthesis in cartilage. PDGF increases chondrocyte proliferation and proteoglycan synthesis and IGF-1 stimulates proteoglycan synthesis, while delaying its catabolism ( Ziltener et al., 2012 ; Chevalier, 2010 ).…”

“…In this context, the use of autologous material as an adjuvant in the healing process has been widely studied. Among them, many blood products have been studied, such as platelet-rich plasma (PRP) or plasma rich in growth factors, autologous conditioned serum, autologous blood preparations, and autologous protein concentrates ( Ziltener et al., 2012 ; Chevalier, 2010 ). Hyaluronic acid (HA) is responsible for most of the viscoelastic properties of synovial fluid, and its intra-articular use has been proposed as a potential treatment for joint diseases for a long time ( Howard & McIIwraith, 1993 ).…”

The Use of Platelet-Rich Plasma for Treatment of Tenodesmic Lesions in Horses: A Systematic Review and Meta-Analysis of Clinical and Experimental Data

“…Systematic PRP evaluation for repairing tendon and ligament injuries may provide a scientific reference for treatment and clinical application strategies. Indeed, although in human and veterinary medicine several systematic reviews and meta-analyses have been subsequently published [ 3 , 15 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ], it is still not clear which product or combination of substrates is most appropriate related to individual cases. Due to the variety of lesions and products, clinical studies would require large numbers, with economic and ethical concerns [ 30 , 31 , 32 ].…”