Optimization of Leukocyte Concentration in Platelet-Rich Plasma for the Treatment of Tendinopathy

McCarrel, Taralyn M.; Minas, Tom; Fortier, Lisa A.

doi:10.2106/jbjs.l.00019

Cited by 312 publications

(291 citation statements)

References 44 publications

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“…Neutrophils have been shown to contribute to oxidative damage and impair the resolution of contraction-induced muscle injury in mice [14]. Leukocytes secrete cytokines and other mediators that increase catabolism by promoting inflammatory responses via tumor necrosis factor-alpha (TNF-alpha), interleukin-1 (IL-1), and by decreasing extracellular matrix synthesis [15]. Heightened catabolism is associated with decreased sheer/tensile strength of soft-tissue and has been correlated with decreased recovery and healing.…”

Section: Pathophysiology and Mechanisms Of Muscle Healingmentioning

confidence: 99%

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

Mosca

Rodeo

2015

Curr Rev Musculoskelet Med

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Muscle injuries are common and may be associated with impaired functional capacity, especially among athletes. The results of healing with conventional therapy including rest, ice, compression, and elevation (RICE) are often inadequate, generating substantial interest in the potential for emerging technologies such as platelet-rich plasma (PRP) to enhance the process of soft-tissue healing and to decrease time to recovery. In vitro studies and animal research have suggested that PRP may have benefits associated with the increased release of cytokines and growth factors resulting from supraphysiological concentrations of platelets that facilitate muscle repair, regeneration, and remodeling. Despite the promise of basic science, there is a paucity of clinical data to support the theoretical benefits of PRP. The only double-blind controlled clinical trial was recently reported and showed no benefit of PRP in the time to resume sports activity among athletes with hamstring muscle injury. This review examines the current evidence and the theoretical framework for PRP and muscle healing. Scientific gaps and technological barriers are discussed that must be addressed if the potential promise of PRP as a therapeutic modality for muscle injury is to be realized.

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Section: Pathophysiology and Mechanisms Of Muscle Healingmentioning

confidence: 99%

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

Mosca

Rodeo

2015

Curr Rev Musculoskelet Med

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“…Dragoo et al [21] showed that leukocyte-rich PRP had a greater inflammatory response relative to leukocyte-poor PRP at post-injection day 5, but there was no difference at day 14. McCarrel et al [22] demonstrated that leukocytereduced PRP had decreased levels of tumor necrosis factor alpha and interleukin 1 beta relative to standard PRP, highconcentration PRP, and concentrated-leukocyte PRP.…”

Section: Prp Duration Of Effectmentioning

confidence: 99%

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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“…Regarding the optimal concentration of the platelets in PRP for the tendon healing, some researchers reported in vitro studies. McCarrell demonstrated that the PRP at the platelets concentration of 1.2×10 6 /µL led to a paradoxical effect on collagen synthesis on the culture of horse tendons compared to the PRP at the intermediate concentration of the platelets, while also presenting an increase in inflammatory mediators 24 . Boswell also demonstrated that the PRP at the high platelets concentration reduced tendon metabolism and collagen synthesis in equine tendon culture 25 .…”

Section: Introductionmentioning

confidence: 99%

Efficacy of autologous leukocyte-reduced platelet-rich plasma therapy for patellar tendinopathy in a rat treadmill model

Yoshida

Funasaki

Marumo

2016

MLTJ

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SummaryBackground: An autologous platelet-rich plasma (PRP) therapy has currently been applied for the tendinopathy; however, its efficacy and an optimal platelets concentration in PRP were uncertain. We analyzed them in an animal model prepared using a repetitive running exercise. Methods: We made the tendinopathy rat model of patellar tendon using a rodent treadmill machine. Rats with tendinopathy were injected with leukocyte-reduced PRP at the platelets concentration of 1.0×10 6 /µL (P10 group), PRP at the platelets concentration of 5.0×10 5 /µL (P5 group) or normal saline (control group) into the space between the patellar tendon and the fat pad bilaterally or were multiply dry-needled at the tibial insertion site (MN group) at once. To assess the pain-reliving effect, the spontaneous locomotor activities at night (12 h) were measured every day. Histological sections of the patellar tendon stained with hematoxylineosin or prepared by TdT-mediated dUTP nick end labeling were microscopically analyzed. Results: The numbers of spontaneous locomotor activities in the P10 group were significantly larger than those in the P5, MN or control groups and they recovered up to a healthy level. On histologic examinations, the numbers of microtears, laminations, or apoptotic cells in the patellar tendons in the P10 or P5 groups were significantly lower than those in the MN or control groups, although no significant differences were observed between the P10 and P5 groups. Conclusions:The injections of an autologous leukocyte-reduced PRP were effective for pain relief and for partial restoration of the patellar tendon in the tendinopathy rat model. The injections of a PRP at the platelets concentration of 1.0×10 6 /µL completely relieved the pain and were more effective than those at the platelets concentration of 5.0×10 5 /µL whereas there was no difference for the effect of histological restoration or apoptosis inhibition between them.

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Optimization of Leukocyte Concentration in Platelet-Rich Plasma for the Treatment of Tendinopathy

Cited by 312 publications

References 44 publications

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

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

PRP: review of the current evidence for musculoskeletal conditions

Efficacy of autologous leukocyte-reduced platelet-rich plasma therapy for patellar tendinopathy in a rat treadmill model

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