Temporal and spatial expression of TGF-β1 in an Achilles tendon section model after application of platelet-rich plasma

Lyras, Dimitrios N; Kazakos, Konstantinos; Tryfonidis, M.; Agrogiannis, George; Botaitis, Sotirios; Kokka, Anna; Drosos, George; Tilkeridis, Konstantinos; Verettas, D.

doi:10.1016/j.fas.2009.09.002

Cited by 35 publications

(23 citation statements)

References 26 publications

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“…Thirteen studies published in 14 papers were included for final analysis 9, 10, 19–30. Ten papers focused on models and trial of Achilles tendon rupture repair, and four papers focused on Achilles tendinopathy.…”

Section: Resultsmentioning

confidence: 99%

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The role of platelets in the treatment of Achilles tendon injuries

Sadoghi

Rosso

Valderrábano

et al. 2012

Journal Orthopaedic Research

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ABSTRACT:To systematically review the current in-vivo evidence for the use of platelet-concentrates (PRP) in the treatment of Achilles tendinopathy and Achilles tendon ruptures in animal models and human applications. A systematic search of PubMed, CINAHL, EMBASE, CCTR, and CDSR was performed for animal and human studies on the effect of platelet-concentrates in the treatment of Achilles tendinopathy and ruptures using the terms ''Achilles tendon and platelet.'' The systematic search revealed a total of 149 papers. After excluding duplicates and cases of overlapping data, studies not focusing on in vivo evidence in terms of treatment or outcome, studies without any intervention, studies with unacceptable high attrition, one Chinese and one Swedish study, the remaining 14 manuscripts were included. The key finding of our study is evidence in support of a statistically significant effect of platelet concentrates in the treatment of Achilles tendon ruptures in vivo in animal models and human application, consistent with a medium to large sized effect. This effect is most likely attributable to fastened and enhanced scar tissue maturation. There was no evidence for a beneficial effect of platelets in Achilles tendinopathy. Keywords: achilles tendon; platelet; PRP; evidence-based medicine; meta-analysis Ligament and tendon healing is an important topic in orthopedics and orthopedic sports medicine.1 Among the most promising approaches is the use of platelet concentrates such as platelet-rich plasma (PRP). Platelets are a source of a plethora of growth factors that stimulate healing and provide a temporary matrix that fills defects sites and serves as a matrix for cell migration and tissue remodeling. 2-4The Achilles tendon is one of the most vulnerable tendons of the human body 5,6 and it is estimated that Achilles tendon injuries are involved in 30-50% of all sports-related injuries.7 About 7-10 ruptures are reported per 100,000, typically occurring in men aged 30-50. 7 The diagnosis of Achilles tendinopathy and tears can be made easily in the presence of a painful, swollen tendon with impaired function, which is evaluated using the Simmonds-Thompson test.8 Platelets have been used to fix Achilles tendon ruptures and Achilles tendinopathy in in vivo settings.9,10 However, the benefit of platelets in regeneration of Achilles tendinopathy and Achilles tendon tears is still elusive as this is a relatively new treatment option and their effectiveness is still not comprehensively analyzed and described.The objectives of this meta-analysis and systematic review were twofold. The first objective was to systematically review the current in vivo evidence for the use of plateletes for the treatment of Achilles tendon rupture and perform a meta-analysis. The secondary objective was to systematically review the current in vivo evidence for the use of platelet-concentrates for the treatment of Achilles tendinopathy and perform a meta-analysis. MATERIALS AND METHODSThis systematic review was performed in accordance to the PRISMA ...

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Section: Resultsmentioning

confidence: 99%

“…Three studies report on the use of platelets in human Achilles tendinopathy 9, 20, 28. All three studies used platelets as an adjunct to eccentric exercises.…”

Section: Resultsmentioning

confidence: 99%

The role of platelets in the treatment of Achilles tendon injuries

Sadoghi

Rosso

Valderrábano

et al. 2012

Journal Orthopaedic Research

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“…Mishra and Pavelko were the first to publish a human pilot trial for a sports medicine application [5]. Over the last several years, many more basic science and clinical investigations have been published supporting the use of PRP for sports related injuries and disorders [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21]. It is difficult to directly compare studies because there is a lack of a coherent nomenclature or classification system for PRP.…”

Section: Introductionmentioning

confidence: 99%

Sports Medicine Applications of Platelet Rich Plasma

Mishra

Harmon

Woodall

et al. 2012

CPB

333

209

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Platelet rich plasma (PRP) is a powerful new biologic tool in sports medicine. PRP is a fraction of autologous whole blood containing and increased number of platelets and a wide variety of cytokines such as platelet derived growth factor (PDGF), vascular endothelial growth factor (VEGF) and transforming growth factor beta-1 (TGF-B1), fibroblast growth factor (FGF), Insulin-like growth factor-1 (IGF-1) among many others. Worldwide interest in this biologic technology has recently risen sharply. Basic science and preclinical data support the use of PRP for a variety of sports related injuries and disorders. The published, peer reviewed, human data on PRP is limited. Although the scientific evaluation of clinical efficacy is in the early stages, elite and recreational athletes already use PRP in the treatment of sports related injuries. Many questions remain to be answered regarding the use of PRP including optimal formulation, including of leukocytes, dosage and rehabilitation protocols. In this review, a classification for platelet rich plasma is proposed and the in-vitro, preclinical and human investigations of PRP applications in sports medicine will be reviewed as well as a discussion of rehabilitation after a PRP procedure. The regulation of PRP by the World Anti-Doping Agency will also be discussed. PRP is a promising technology in sports medicine; however, it will require more vigorous study in order to better understand how to apply it most effectively.

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“…A 30% increase in tendon callus strength and stiffness of transacted rat Achilles tendons at 1 week was noted following percutaneous injections of PRP [25]. Other series report similar improvements in early healing, with increased strength of repair at 1 week post injection [26][27][28]. A placebocontrolled experimental trial in horses reported less inflammation and increased metabolic activity and maturation, higher strength at failure and elastic modulus in tendons treated with PRP [29].…”

Section: Current Evidence Of the Efficacy Of Platelet-rich Plasmamentioning

confidence: 74%