Platelet rich plasma injection grafts for musculoskeletal injuries: a review

In Europe and the United States, there is an increasing prevalence of the use of autologous blood products to facilitate healing in a variety of applications. Recently, we have learned more about specific growth factors, which play a crucial role in the healing process. With that knowledge there is abundant enthusiasm in the application of concentrated platelets, which release a supra-maximal quantity of these growth factors to stimulate recovery in non-healing injuries. For 20 years, the application of autologous PRP has been safely used and documented in many fields including; orthopedics, sports medicine, dentistry, ENT, neurosurgery, ophthalmology, urology, wound healing, cosmetic, cardiothoracic, and maxillofacial surgery. This article introduces the reader to PRP therapy and reviews the current literature on this emerging treatment modality. In summary, PRP provides a promising alternative to surgery by promoting safe and natural healing. However, there are few controlled trials, and mostly anecdotal or case reports. Additionally the sample sizes are frequently small, limiting the generalization of the findings. Recently, there is emerging literature on the beneficial effects of PRP for chronic non-healing tendon injuries including lateral epicondylitis and plantar fasciitis and cartilage degeneration (Mishra and Pavelko, The American Journal of Sports Medicine 10(10):1–5, 2006; Barrett and Erredge, Podiatry Today 17:37–42, 2004). However, as clinical use increases, more controlled studies are needed to further understand this treatment.

[1]  G. Crovetti,et al.  Platelet gel for healing cutaneous chronic wounds. , 2004, Transfusion and apheresis science : official journal of the World Apheresis Association : official journal of the European Society for Haemapheresis.

[2]  B. Weiner,et al.  Efficacy of Autologous Growth Factors in Lumbar Intertransverse Fusions , 2003, Spine.

[3]  G. Hayem Tenology: a new frontier. , 2001, Joint, bone, spine : revue du rhumatisme.

[4]  P. Nurden,et al.  New insights into and novel applications for platelet-rich fibrin therapies. , 2006, Trends in biotechnology.

[5]  B. Peltier Dental and Craniofacial Applications of Platelet-Rich Plasma , 2007 .

[6]  T. Pavelko,et al.  Treatment of Chronic Elbow Tendinosis with Buffered Platelet-Rich Plasma , 2006, The American journal of sports medicine.

[7]  S. Glassman,et al.  Platelet Gel (AGF) Fails to Increase Fusion Rates in Instrumented Posterolateral Fusions , 2005, Spine.

[8]  S. Werner,et al.  Regulation of wound healing by growth factors and cytokines. , 2003, Physiological reviews.

[9]  P. Nurden,et al.  Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture , 2005, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[10]  R. Devilee,et al.  Platelet gel and fibrin sealant reduce allogeneic blood transfusions in total knee arthroplasty , 2006, Acta anaesthesiologica Scandinavica.

[11]  J. Calandruccio,et al.  Autologous blood injections for refractory lateral epicondylitis. , 2003, The Journal of hand surgery.

[12]  F. Castro Role of Activated Growth Factors in Lumbar Spinal Fusions , 2004, Journal of spinal disorders & techniques.

[13]  G. Lowery,et al.  Use of autologous growth factors in lumbar spinal fusion. , 1999, Bone.

[14]  N Maffulli,et al.  Patellar tendinopathy: some aspects of basic science and clinical management. , 1998, British journal of sports medicine.

[15]  H. Hee,et al.  Do autologous growth factors enhance transforaminal lumbar interbody fusion? , 2003, European Spine Journal.

[16]  L. Bouter,et al.  Effectiveness of physiotherapy for lateral epicondylitis: a systematic review , 2003, Annals of medicine.

[17]  Steven A Fenwick,et al.  The vasculature and its role in the damaged and healing tendon , 2002, Arthritis research.

[18]  M. Gardner,et al.  The efficacy of autologous platelet gel in pain control and blood loss in total knee arthroplasty , 2007, International Orthopaedics.

[19]  Sheldon S. Lin,et al.  The effects of blood glucose control upon fracture healing in the BB Wistar rat with diabetes mellitus , 2002, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[20]  B. Kwon,et al.  A prospective study of Autologous Growth Factors (AGF) in lumbar interbody fusion. , 2006, The spine journal : official journal of the North American Spine Society.

[21]  G. Hayem Le tendon normal et pathologique , 2001 .

[22]  J. Zehnder,et al.  Development of antibodies to thrombin and factor V with recurrent bleeding in a patient exposed to topical bovine thrombin. , 1990, Blood.

[23]  J. Blaha,et al.  The response of rabbit patellar tendons after autologous blood injection. , 2002, Medicine and science in sports and exercise.

[24]  M. Valbonesi,et al.  A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac surgery , 1987, The International journal of artificial organs.

[25]  W. S. Pietrzak,et al.  Platelet-rich plasma application during closure following total knee arthroplasty. , 2006, Orthopedics.

[26]  B. Cahill,et al.  Weight training-related injuries in the high school athlete , 1982, The American journal of sports medicine.

[27]  R. Marx,et al.  Platelet-rich plasma (PRP): what is PRP and what is not PRP? , 2001, Implant dentistry.

[28]  G. Murrell,et al.  The Roles of Growth Factors in Tendon and Ligament Healing , 2003, Sports medicine.

[29]  A. Nurden,et al.  Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. , 2007, Rheumatology.

[30]  B. Boyan,et al.  Platelet-rich plasma inhibits demineralized bone matrix-induced bone formation in nude mice. , 2007, The Journal of bone and joint surgery. American volume.

[31]  A. Woolf,et al.  Burden of major musculoskeletal conditions. , 2003, Bulletin of the World Health Organization.

[32]  B. Eppley,et al.  Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. , 2004, Plastic and reconstructive surgery.

[33]  T. Kubo,et al.  Platelet‐rich plasma enhances the initial mobilization of circulation‐derived cells for tendon healing , 2008, Journal of cellular physiology.

[34]  Sheldon S. Lin,et al.  The effects of local platelet rich plasma delivery on diabetic fracture healing. , 2006, Bone.

[35]  Fulin Chen,et al.  Autologous injectable tissue-engineered cartilage by using platelet-rich plasma: experimental study in a rabbit model. , 2007, Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons.

[36]  Jody P. McAleer,et al.  Efficacy of concentrated autologous platelet-derived growth factors in chronic lower-extremity wounds. , 2006, Journal of the American Podiatric Medical Association.

[37]  E. Hunziker,et al.  Chondrogenesis in Cartilage Repair is Induced by Members of the Transforming Growth Factor-Beta Superfamily , 2001, Clinical orthopaedics and related research.

[38]  A. V. van Zundert,et al.  Platelet-rich plasma and platelet gel: a review. , 2006, The journal of extra-corporeal technology.

[39]  C. Su,et al.  Tissue‐engineered intervertebral disc and chondrogenesis using human nucleus pulposus regulated through TGF‐β1 in platelet‐rich plasma , 2006, Journal of cellular physiology.

[40]  F. Jobe,et al.  Lateral and Medial Epicondylitis of the Elbow , 1994, The Journal of the American Academy of Orthopaedic Surgeons.

[41]  G. Hayem The normal tendon and the abnormal tendon , 2001 .

[42]  A. Vissink,et al.  Does platelet-rich plasma promote remodeling of autologous bone grafts used for augmentation of the maxillary sinus floor? , 2005, Clinical oral implants research.

[43]  T. Sasho,et al.  P181 Effects of autologous platelet-rich plasma on the metabolism of human articular chondrocytes , 2007 .

[44]  S. Watt-Smith Dental and craniofacial applications of platelet-rich plasma , 2005, British Dental Journal.

[45]  R. Nucci Re: Weiner BK, Walker M. Autologous growth factors and lumbar intertransverse fusions. Spine 2003;28: 1968-70; discussion 1971. , 2004, Spine.

[46]  S. Furner,et al.  Musculoskeletal Conditions in the United States , 1992 .

[47]  D. Baksi Fracture healing. , 1980, Journal of the Indian Medical Association.

[48]  S. Nakano,et al.  Experimental study in a rabbit model of ischemia-reperfusion lung injury during cardiopulmonary bypass. , 1992, The Journal of thoracic and cardiovascular surgery.

[49]  B. Eppley,et al.  Platelet Rich Plasma: Biology and New Technology , 2005, The Journal of craniofacial surgery.

[50]  S. Froum,et al.  Effect of platelet-rich plasma on bone growth and osseointegration in human maxillary sinus grafts: three bilateral case reports. , 2002, The International journal of periodontics & restorative dentistry.

[51]  M. de la Fuente,et al.  Autologous fibrin matrices: a potential source of biological mediators that modulate tendon cell activities. , 2006, Journal of biomedical materials research. Part A.

[52]  N. Maffulli,et al.  Achilles tendinopathy: some aspects of basic science and clinical management , 1998, British journal of sports medicine.

[53]  C. Kirker-Head,et al.  Potential applications and delivery strategies for bone morphogenetic proteins. , 2000, Advanced drug delivery reviews.