Platelet-rich plasma in orthopaedic sports medicine: state of the art

Abstract

Platelet-rich plasma (PRP) is one of the many new developments within the expanding field of regenerative medicine. It aims to improve the process of tissue repair through local delivery of autologous bioactive agents to influence critical physiological mechanisms such as inflammation, angiogenesis or extracellular matrix synthesis. Within orthopaedics and sports medicine, the use of PRP has been rapidly increasing in popularity as patients seek non-surgical approaches to acute and chronic musculoskeletal injury and disease. The popularity of this new treatment option has prompted a rapid increase in research endeavours. Although preclinical studies were encouraging, clinical studies often reported controversial results. The differences in the composition and application techniques of PRP have made comparisons regarding its efficacy difficult and somehow inconclusive. Although PRP appears to be a safe treatment option with potentially beneficial effects to injured musculoskeletal tissues, continuous efforts are needed to identify factors that influence the biological response to PRP treatment. It is likely that in the near future the PRP preparation will be tailored not only to the specific pathology of interest but also to stage of disease. However, the growing emphasis on an evidence-based approach in the sports medicine setting demands additional research efforts before incorporating this technology in routine clinical care. The current review explores the latest findings on PRP efficacy in several musculoskeletal conditions, focusing on results of the highest level of evidence available.

Comparação entre viscossuplementação e plasma rico em plaquetas em lesões condrais de joelhos de pacientes jovens

“…Platelet-rich plasma has been used successfully to treat osteoarthritis. 15 16 17 18 19 20 These effects are even better in younger patients with milder joint involvement. 17 21 22 23 However, there was still no study evaluating its application in focal knee chondral lesions with no arthrosis.…”

“…The best platelet concentration also remains unknown, potentially requiring an evaluation and quantification of the best growth factor or cytokine present in PRP for each target tissue . 18,19,25,26 Leukocytes can cause adverse effects, such as reaction arthritis; in addition, these cells stimulate chondral catabolism. 23,27 As a result, we used a leukocyte-poor PRP which may have influenced the outcomes in favor of this therapy.…”

“…Também não se sabe qual concentração de plaquetas seria melhor, discutindo-se até que, na verdade, teríamos que avaliar e quantificar o melhor fator de crescimento ou citocina presente no PRP para cada tecido alvo. 18,19,25,26 Os leucócitos podem causar efeitos adversos, tais como artrite reacional, além de poder estimular o catabolismo condral. 23,27 Por isso, optamos, em nosso estudo, pelo uso de PRP pobre em leucócitos, o que pode ter influenciado nos resultados a favor do PRP.…”

The future of meniscus science: international expert consensus

“…This meniscus expert panel collectively suggests focusing future research and development on meniscal preservation through meniscus repair and the use of orthobiologics. Recent evidence including basic science and expert consensus statements have led to an improved understanding of treating meniscal lesions and use of biologic augmentation [ 4 , 14 , 20 , 26 , 28 , 36 , 40 , 45 , 47 ]. Both clinical outcomes data and animal models indicate promising results for meniscal repair and the potential for improved meniscal healing with biologic augmentation [ 23 , 31 , 35 , 37 ].…”

Human platelet lysate – A potent (and overlooked) orthobiologic

“…To be defined as a "working PRP", the platelet concentration should be around 10 6 per microliter, since higher concentrations have not shown enhancements tissue healing. 6 Platelet-rich plasma (PRP) is also defined as platelets concentrated over the basal number (four-to nine-fold) in a small plasma volume.…”