Use of Platelet-Rich Plasma Immediately After an Injury Did Not Improve Ligament Healing, and Increasing Platelet Concentrations Was Detrimental in an In Vivo Animal Model

LaPrade, Robert F.; Goodrich, Laurie R.; Phillips, Jennifer N; Dornan, Grant J.; Turnbull, Travis Lee; Hawes, Michael; Dahl, Kimi D.; Coggins, Ashley; Kisiday, John D.; Frisbie, David D.; Chahla, Jorge

doi:10.1177/0363546517741135

Cited by 42 publications

(30 citation statements)

References 43 publications

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“…12 Nevertheless, it seems that stimulation has some limitations. In a rabbit model, LaPrade et al 22 illustrated negative biomechanical effects for higher PRP concentrations with respect to maximum load and stiffness of treated medial collateral ligament injuries. Moreover, in equine chondrocytes, a potential ceiling effect of PRP concentration with anti-inflammatory and anabolic characteristics could be seen.…”

Section: Discussionmentioning

confidence: 99%

Dose-Dependent Effects of Platelet-Rich Plasma Powder on Chondrocytes In Vitro

et al. 2020

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Background: Platelet-rich plasma (PRP) is widely used in sports medicine. However, neither preparation nor parameters for clinical application, such as concentration, timing, and number of applications, are standardized, making research and clinical utilization challenging. Purpose: To investigate the effect of varying doses of PRP powder in terms of different concentrations, timing, and number of applications on human chondrocytes in a reproducible cell culture model. Study Design: Controlled laboratory study. Methods: A standardized lyophilized platelet growth factor preparation (PRP powder) was used to stimulate human chondrocytes. Chondrocytes were cultivated for 2 weeks with different stimulation frequencies (2×, 3×, 6×) and different concentrations of PRP powders (0.5%, 1%, 5%). Cell proliferation and metabolic cell activity were analyzed on days 7 and 14. Phenotypic changes were visualized through live-dead staining. Chondrogenic differentiation was quantified with enzyme-linked immunosorbent assay to assess the synthesis of procollagen types 1 and 2. Furthermore, sulfated proteoglycans and glycosaminoglycans were analyzed. Results: Human chondrocytes exhibited a significant dose- and time-dependent increase after 14 days in cell number (1% and 5% PRP powder vs unstimulated control: 7.95- and 15.45-fold increase, respectively; 2× vs 6× stimulation with 5% PRP powder: 4.00-fold increase) and metabolic cell activity (1% and 5% PRP powder vs unstimulated control: 3.27-fold and 3.58-fold change, respectively). Furthermore, cells revealed a significant increase in the amount of bone-specific procollagen type 1 (14 days, 1.94-fold) and sulfated glycosaminoglycans (14 days, 2.69-fold); however, no significant change was observed in the amount of cartilage-specific collagen type 2. Conclusion: We showed that chondrocytes exhibit a significant dose- and time-dependent increase in cell number and metabolic cell activity. The standardized use of growth factor concentrates in cell culture models can contribute to clinical knowledge in terms of dosage and timing of PRP applications. Clinical Relevance: Problems with PRP, such as the absence of standardization, lack of consistency among studies, and unknown dosage, could be solved by using characterized PRP powder made by pooling and lyophilizing multiple platelet concentrates. The innovative PRP powder generates new possibilities for PRP research, as well as for the treatment of patients.

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Section: Discussionmentioning

confidence: 99%

Dose-Dependent Effects of Platelet-Rich Plasma Powder on Chondrocytes In Vitro

et al. 2020

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“…9,10,29 However, the biological value of PRP in the management of acute ligament injuries has been recently challenged. 24 To date, there have been no large comparative studies evaluating the nonoperative treatment of UCL injuries with or without PRP in only professional baseball players.…”

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confidence: 99%

Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries With and Without Platelet-Rich Plasma in Professional Baseball Players: A Comparative and Matched Cohort Analysis

et al. 2019

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Background: Recent studies evaluating nonoperative treatment of elbow ulnar collateral ligament (UCL) injuries augmented with platelet-rich plasma (PRP) have shown promising results. To date, no comparative studies have been performed on professional baseball players who have undergone nonoperative treatment with or without PRP injections for UCL injuries. Hypothesis: Players who received PRP injections would have better outcomes than those who did not receive PRP. Study Design: Cohort study; Level of evidence, 3. Methods: The Major League Baseball (MLB) Health and Injury Tracking System identified 544 professional baseball players who were treated nonoperatively for elbow UCL injuries between 2011 and 2015. Of these, 133 received PRP injections (PRP group) before starting their nonoperative treatment program, and 411 did not (no-PRP group). Player outcomes and a Kaplan-Meier survival analysis were compared between groups. In addition, to reduce selection bias, a 1:1 matched comparison of the PRP group versus the no-PRP group was performed. Players were matched by age, position, throwing side, and league status: major (MLB) and minor (Minor League Baseball [MiLB]). A single radiologist with extensive experience in magnetic resonance imaging (MRI) interpretation of elbow injuries in elite athletes analyzed 243 MRI scans for which images were accessible for tear location and grade interpretation. Results: Nonoperative treatment of UCL injuries resulted in an overall 54% rate of return to play (RTP). Players who received PRP had a significantly longer delay in return to throwing ( P < .001) and RTP ( P = .012). The matched cohort analysis showed that MLB and MiLB pitchers in the no-PRP group had a significantly faster return to throwing ( P < .05) and the MiLB pitchers in the no-PRP group had a significantly faster RTP ( P = .045). The survival analysis did not reveal significant differences between groups over time. The use of PRP, MRI grade, and tear location were not statistically significant predictors for RTP or progression to surgery. Conclusion: In this retrospective matched comparison of MLB and MiLB pitchers and position players treated nonoperatively for a UCL tear, PRP did not improve RTP outcomes or ligament survivorship, although there was variability with respect to PRP preparations, injection protocols, time from injury to injection, and rehabilitation programs. MRI grade and tear location also did not significantly affect RTP outcomes or progression to surgery.

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“…14,15 However, it has been recently reported that increased platelet concentration beyond the physiological level did not improve functional graft healing in anterior cruciate ligament 16 and medial collateral ligament animal models. 17 Another controversial topic is the concentration of leukocytes. This study used leukocyte-poor PRP, which has been previously reported to produce more consistent results intra-articularly.…”

Section: See Related Article On Page 106mentioning

confidence: 99%

Editorial Commentary: Platelet-Rich Plasma for Knee Osteoarthritis: A “Novel” and Effective Symptomatic Approach

Chahla

Cole

2019

Arthroscopy: The Journal of Arthroscopic & Related Surgery

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Osteoarthritis (OA) constitutes a significant cause of disability, and it is now recognized as a source of increased mortality. Thus, several therapeutic approaches have been reported in the literature in an attempt to mitigate the symptoms of OA with varying degrees of success. Platelet-rich plasma (PRP) is being increasingly accepted as one of the most efficacious approaches for the symptomatic treatment of mild to moderate OA. Several confounding factors can affect the outcome of PRP such as age, grade of OA, PRP processing technique, and number and timing of these injections. However, numerous reports in the literature derived from PRP randomized clinical trials (compared with saline, hyaluronic acid, and other nonsurgical methods) suggest that successful outcomes can be achieved at least at 1-year postinjection with minimal complications.

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Use of Platelet-Rich Plasma Immediately After an Injury Did Not Improve Ligament Healing, and Increasing Platelet Concentrations Was Detrimental in an In Vivo Animal Model

Cited by 42 publications

References 43 publications

Dose-Dependent Effects of Platelet-Rich Plasma Powder on Chondrocytes In Vitro

Dose-Dependent Effects of Platelet-Rich Plasma Powder on Chondrocytes In Vitro

Nonoperative Treatment of Elbow Ulnar Collateral Ligament Injuries With and Without Platelet-Rich Plasma in Professional Baseball Players: A Comparative and Matched Cohort Analysis

Editorial Commentary: Platelet-Rich Plasma for Knee Osteoarthritis: A “Novel” and Effective Symptomatic Approach

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