Updated: 10/30/2016

Platelet-Rich Plasma

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Introduction
  • Platelet rich plasma (PRP) consists of plasma sample from one's own blood enriched with autologous platelets
    • indications
      • controversially used in orthopaedics for possible stimulation of bone and soft tissue healing
    • preparation technique
      • PRP is created by centrifugation of blood to separate platelet rich plasma layer from a sample of whole blood
      • calcium chloride used to initiate platelet activation in the prepared sample of PRP 
    • optimal concentration
      • 3-5x that of whole blood 
        • >5x inhibits healing
  • Platelet function
    • plays an important role in the inflammatory cascade response after injury
    • growth factors released from platelets include
      • PDGF
      • TGF-B
      • VEGF
      • IGF-1
      • EGF (epidermal growth factor)
      • CTGF (connective tissue growth factor)
      • FGF-2
  • Proposed function of PRP
    • increase ECM deposition
    • reduce pro-apoptotic signals
    • minimize joint inflammation
Clinical Application
  • PRP efficacy is controversial due to small amount of high level studies in literature
    • soft tissue injury healing
      • no consensus for acute ligamentous, tendon and muscle injuries or chronic tendonopathies
    • osteoarthritis
      • no consensus in evidence, lack of studies with long term followup
    • fracture healing / fusion
      • limited evidence for bone formation (some studies show detrimental effects)
    • ACL reconstruction
      • literature does NOT support PRP for ligamentization/graft maturation, patient reported outcomes
      • direct application to patellar and tibial plug donor sites (BPTB) linked to improved patient-reported outcomes of knee function and decreased patellar tendon gap
    • meniscal repair
      • no clear evidence to support use in meniscal repair
    • rotator cuff repair
      • no benefit in augmenting RC repair (possible detrimental effects)
    • tendon healing
      • lateral epicondylar tendinosis (tennis elbow)
        • potential benefit (improved patient reported outcomes and pain scores)
      • midsubstance/insertional Achilles tendinopathy
        • current literature does NOT support 
Summary
  • Potential benefits for BPTB donor sites and tennis elbow
 

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Questions (1)

(OBQ11.206) Platelet-rich plasma (PRP) is created by using a centrifuge to separate it from a sample of whole blood. Which of the following substances is used to initiate platelet activation in the prepared sample of PRP? Tested Concept

QID: 3629
1

Citrate dextrose

25%

(429/1731)

2

Calcium chloride

53%

(913/1731)

3

TGF-beta (transforming growth factor beta)

6%

(101/1731)

4

IL-8

2%

(29/1731)

5

PDGF (platelet derived growth factor)

15%

(254/1731)

L 3 D

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