Platelet rich plasma injection grafts for musculoskeletal injuries: a review

In Europe, and more recently in the United States, anincreased trend has emerged in the use of autologous bloodproducts in an effort to facilitate healing in a variety ofapplications. In recent years, scientific research and technologyhas provided a new perspective on understanding thewound healing process. Initially platelets were thought to actexclusively with clotting.
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Platelet rich plasma injection grafts for musculoskeletal injuries: a reviewCurr Rev Musculoskelet MedDOI 10.1007/s12178-008-9032-5Platelet rich plasma injection grafts for musculoskeletal injuries:a reviewSteven Sampson Æ Michael Gerhardt ÆBert MandelbaumÓ Humana Press 2008Abstract In Europe and the United States, there is an Keywords Platelet rich plasma Á Injection Áincreasing prevalence of the use of autologous blood Growth factors Á Tendon injury Á Autologous blood Áproducts to facilitate healing in a variety of applications. Musculoskeletal injuries Á Chondropenia ÁRecently, we have learned more about specific growth Knee osteoarthritisfactors, which play a crucial role in the healing process.With that knowledge there is abundant enthusiasm in theapplication of concentrated platelets, which release a Introductionsupra-maximal quantity of these growth factors to stimu-late recovery in non-healing injuries. For 20 years, the In Europe, and more recently in the United States, anapplication of autologous PRP has been safely used and increased trend has emerged in the use of autologous blooddocumented in many fields including; orthopedics, sports products in an effort to facilitate healing in a variety ofmedicine, dentistry, ENT, neurosurgery, ophthalmology, applications. In recent years, scientific research and tech-urology, wound healing, cosmetic, cardiothoracic, and nology has provided a new perspective on understanding themaxillofacial surgery. This article introduces the reader to wound healing process. Initially platelets were thought to actPRP therapy and reviews the current literature on this exclusively with clotting. However, we have learned thatemerging treatment modality. In summary, PRP provides a platelets also release many bioactive proteins responsible forpromising alternative to surgery by promoting safe and attracting macrophages, mesenchymal stem cells, and oste-natural healing. However, there are few controlled trials, oblasts which not only promotes removal of necrotic tissue,and mostly anecdotal or case reports. Additionally the but also enhances tissue regeneration and healing.sample sizes are frequently small, limiting the generaliza- Based on this principle platelets are introduced to stim-tion of the findings. Recently, there is emerging literature ulate a supra-physiologic release of growth factors in anon the beneficial effects of PRP for chronic non-healing attempt to jump start healing in chronic injuries. The currenttendon injuries including lateral epicondylitis and plantar literature reveals a paucity of randomized clinical trials. Thefasciitis and cartilage degeneration (Mishra and Pavelko, existing literature is filled with mostly anecdotal reports orThe American Journal of Sports Medicine 10(10):1–5, case series, which typically have small sample sizes and few2006; Barrett and Erredge, Podiatry Today 17:37–42, control groups [1, 2]. A large multi-center trial is currently2004). However, as clinical use increases, more controlled underway providing a more objective understanding ofstudies are needed to further understand this treatment. Platelet Rich Plasma (PRP) use in chronic epicondylitis. According to the World Health Organization (WHO), musculoskeletal injuries are the most common cause ofS. Sampson (&) severe long-term pain and physical disability, and affectThe Orthobiologic Institute (TOBI), Santa Monica, CA, USA hundreds of millions of people around the world [3]. Ine-mail: drsampson@orthohealing.com fact, the years 2000–2010 have been termed ‘‘the decade ofM. Gerhardt Á B. Mandelbaum bone and joint’’ as a global initiative to promote furtherSanta Monica Orthopaedic Group, Santa Monica, CA, USA research on prevention, diagnosis, and treatment [3, 4]. Curr Rev Musculoskelet MedSoft tissue injuries including tendon and ligament trauma the manufacturer’s equipment. However, it has not beenrepresent 45% of all musculoskeletal injuries in the USA studied if too great an increased platelet concentration[4, 5]. The continued popularity of sporting activities has would have paradoxical effects.brought with it an epidemic of musculoskeletal disorders The use of autologous PRP was first used in 1987 byfocusing attention on tendons. Additionally, modern Ferrari et al. [10] following an open heart surgery, to avoidimaging techniques including magnetic resonance imaging excessive transfusion of homologous blood products. Sinceand musculoskeletal ultrasound have provided clinicians that time, the application of autologous PRP has beenwith further knowledge of these injuries. safely used and documented in many fields including; orthopedics, sports medicine, dentistry, ENT, neurosur- gery, ophthalmology, urology, and wound healing; as wellBlood components as cosmetic, cardiothoracic, and maxillofacial surgery. Studies suggest that PRP can affect inflammation, post-Blood contains plasma, red blood cells (RBC), white blood operative blood loss, infection, narcotic requirements,cells ...