PRP Treatment Efficacy for Tendinopathy: A Review of Basic Science Studies

Abstract

Platelet-Rich Plasma (PRP) has been widely used in orthopaedic surgery and sport medicine to treat tendon injuries. However, the efficacy of PRP treatment for tendinopathy is controversial. This paper focuses on reviewing the basic science studies on PRP performed under well-controlled conditions. Both in vitro and in vivo studies describe PRP's anabolic and anti-inflammatory effects on tendons. While some clinical trials support these findings, others refute them. In this review, we discuss the effectiveness of PRP to treat tendon injuries with evidence presented in basic science studies and the potential reasons for the controversial results in clinical trials. Finally, we comment on the approaches that may be required to improve the efficacy of PRP treatment for tendinopathy.

Differential effect of platelet-rich plasma fractions on β1-integrin signaling, collagen biosynthesis, and prolidase activity in human skin fibroblasts

“…Moreover, PRP consists of plasma proteins, leukocytes, and erythrocytes. PRP is also a rich source of many cytokines and growth factors (GFs) 2–4. It has been hypothesized that the PLTs, and particularly platelet-derived growth factors (PDGFs) contained in their alpha granules, are responsible for the biologic effects of PRP 5,6…”

“…Other GFs present in PLT granules are the vascular endothelial growth factors and the endothelial growth factors. The interaction between these GFs and the surface receptors on the target cells activates intracellular signaling pathways, which induces the expression of genes required for regenerative processes such as cellular proliferation and extracellular matrix formation 2–4,7…”

“…Numerous reports suggest the use of PRP in delayed bone healing and nonunions, chondropathy, osteoarthritis, tendinopathy, acute and chronic soft-tissue injuries, enhancement of healing after ligament reconstruction, muscle strains, and in skin rejuvenation 2–4,20. The specific role of collagen in bones, tendons, ligaments and skin repair is well established 21,22.…”

Diagnosis and Treatment of Gouty Tophi in the Patellar Tendon Using Ultrasound‐Guided Needle Barbotage: A Case Presentation

“…To our knowledge, there are no published data regarding PRP injection as an adjunct treatment after ultrasound‐guided needle barbotage of gouty tophi. PRP has been shown to recruit proinflammatory and anti‐inflammatory growth factors, which initiate and regulate the healing process [13]. The latest Cochrane review notes insufficient evidence for PRP in the treatment of a variety of musculoskeletal soft tissue injuries with a need for standardization of the platelet acquisition, preparation, and procedure.…”

Conservative treatment for Insertional Achilles Tendinopathy: platelet-rich plasma and focused shock waves. A retrospective study

“…The rational of applying in vivo ESWT on tendons is supported by the results obtained with shockwaves on models in vitro, such as enhancing cell proliferation, migration and secretory activity of human primary cultured tenocytes 44 . Basic science studies about PRP mechanism action show that growth factors in PRP significantly enhance the healing of tendon injuries such as tendinopathy 45 . In scientific literature, there is no evidence about the most effective non-surgical intervention for IAT 46 .…”