Platelet-rich Plasma in Orthopaedic Applications: Evidence-based Recommendations for Treatment

Abstract

Autologous platelet-rich plasma (PRP) therapies have seen a dramatic increase in breadth and frequency of use for orthopaedic conditions in the past 5 years. Rich in many growth factors that have important implications in healing, PRP can potentially regenerate tissue via multiple mechanisms. Proposed clinical and surgical applications include spinal fusion, chondropathy, knee osteoarthritis, tendinopathy, acute and chronic soft-tissue injuries, enhancement of healing after ligament reconstruction, and muscle strains. However, for many conditions, there is limited reliable clinical evidence to guide the use of PRP. Furthermore, classification systems and identification of differences among products are needed to understand the implications of variability.

Cochrane in CORR ®: Platelet-rich Therapies for Musculoskeletal Soft Tissue Injuries (Review)

“…More than 40 commercial PRP systems are available and each product may contain differing concentrations of platelets, leukocytes, and growth factors [2]. Included studies varied in the timespan between PRP preparation and delivery, method of delivery (image, arthroscope, direct vision, or no guidance), number of PRP applications, and postoperative cointerventions [4].…”

“…Factors include the lack of standardization and substantial variations in the concentration of platelets and growth factors among available commercial PRP systems [2]. Furthermore, the most efficacious platelet concentrations are not known, dose-response curves are not linear, saturation effects have been described, and the ideal timing of intervention and elution kinetics of growth factors require further evaluation [2].…”

“…PRP is defined as a sample of autologous blood with supraphysiological concentrations of platelets [2]. Once activated, platelets release bioactive proteins and growth factors that are thought to aid and promote healing [2], but there is substantial controversy regarding their efficacy [3].…”

“…Once activated, platelets release bioactive proteins and growth factors that are thought to aid and promote healing [2], but there is substantial controversy regarding their efficacy [3]. Rigorous evaluation of the available evidence can inform clinicians regarding optimal treatment options for patients.…”

Bench to Bedside: Platelet-rich Plasma—How Do We Adequately “Untranslate” Translational “Breakthroughs” in an After-market Setting?

“…Furthermore, it remains unclear what the ideal concentrations (if any) of platelets, cells, and growth factors for efficacy actually are, and it is probable that these nebulous values vary amongst therapeutic indications. The ideal timing for PRP administration also remains undefined, and may also vary based on the aforementioned factors [9]. Most importantly, evidence of clinical efficacy for most indications is decidedly lacking.…”