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Updated: Jul 29 2023

Platelet-Rich Plasma

  • 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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