Skip to main content
SpringerLink
Log in

Platelet Rich Plasma in Foot and Ankle Surgery

  • Chapter
  • First Online:
Platelet Rich Plasma in Musculoskeletal Practice

  • 1000 Accesses

Abstract

Platelet-rich plasma (PRP) typically contains a fivefold increase in platelet concentration, and can be obtained from autologous blood and/or bone marrow [1]. Alpha-granules, a type of secretory organelle found in platelets, act as a reservoir for a number of different growth factors. In the presence of trauma to bone, platelet activation leads to degranulation of these alpha-granules, which ultimately results in release of these growth factors localized to the site of injury (Table 7.1). Platelet-derived growth factor (PDGF), insulin-like growth factor (IGF) and transforming growth factor (TGF-β1) are among some of the factors released and play critical roles in bone heeling [1, 2]. Human and animal studies have demonstrated increased PDG + F (four to sixfold), IGF-I (one to twofold), TGF-β1 (three to fivefold), vascular endothelial growth factor (VEGF) (four to sixfold), and epidermal growth factor (EGF) (three to fivefold) levels in activated PRP compared to peripheral blood [3, 4].

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Gandhi A, Bibbo C, Pinzur M, Lin SS. The role of platelet-rich plasma in foot and ankle surgery. Foot Ankle Clin. 2005;10(4):621–37, viii.

    Article  PubMed  Google Scholar 

  2. Mehta V. Platelet-rich plasma: a review of the science and possible clinical applications. Orthopedics. 2010;33(2):111.

    Article  PubMed  Google Scholar 

  3. Eppley BL, Woodell JE, Higgins J. Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg. 2004;114(6):1502–8.

    Article  PubMed  Google Scholar 

  4. Frechette JP, Martineau I, Gagnon G. Platelet-rich plasmas: growth factor content and roles in wound healing. J Dent Res. 2005;84(5):434–9.

    Article  CAS  PubMed  Google Scholar 

  5. Doxey DL, Ng MC, Dill RE, Iacopino AM. Platelet-derived growth factor levels in wounds of diabetic rats. Life Sci. 1995;57(11):1111–23.

    Article  CAS  PubMed  Google Scholar 

  6. Einhorn TA, Boskey AL, Gundberg CM, Vigorita VJ, Devlin VJ, Beyer MM. The mineral and mechanical properties of bone in chronic experimental diabetes. J Orthop Res Off Publ Orthop Res Soc. 1988;6(3):317–23.

    Article  CAS  Google Scholar 

  7. Grotendorst GR, Martin GR, Pencev D, Sodek J, Harvey AK. Stimulation of granulation tissue formation by platelet-derived growth factor in normal and diabetic rats. J Clin Invest. 1985;76(6):2323–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Joyce ME, Jingushi S, Scully SP, Bolander ME. Role of growth factors in fracture healing. Prog Clin Biol Res. 1991;365:391–416.

    CAS  PubMed  Google Scholar 

  9. Andrew JG, Hoyland J, Freemont AJ, Marsh D. Insulinlike growth factor gene expression in human fracture callus. Calcif Tissue Int. 1993;53(2):97–102.

    Article  CAS  PubMed  Google Scholar 

  10. Canalis E, Rydziel S, Delany AM, Varghese S, Jeffrey JJ. Insulin-like growth factors inhibit interstitial collagenase synthesis in bone cell cultures. Endocrinology. 1995;136(4):1348–54.

    CAS  PubMed  Google Scholar 

  11. Mohan S, Baylink DJ. Insulin-like growth factor system components and the coupling of bone formation to resorption. Horm Res. 1996;45 Suppl 1:59–62.

    Article  CAS  PubMed  Google Scholar 

  12. Thomas T, Gori F, Spelsberg TC, Khosla S, Riggs BL, Conover CA. Response of bipotential human marrow stromal cells to insulin-like growth factors: effect on binding protein production, proliferation, and commitment to osteoblasts and adipocytes. Endocrinology. 1999;140(11):5036–44.

    CAS  PubMed  Google Scholar 

  13. Arai K-I, Sporn MB, Roberts AB, Battey JF. Peptide growth factors and their receptors. Berlin/ New York: Springer; 1990.

    Google Scholar 

  14. Robey PG, Young MF, Flanders KC, et al. Osteoblasts synthesize and respond to transforming growth factor-type beta (TGF-beta) in vitro. J Cell Biol. 1987;105(1):457–63.

    Article  CAS  PubMed  Google Scholar 

  15. Arnoczky S. What is platelet-rich plasma? Paper presented at: AAOS Now PRP Forum. San Diego; 2011.

    Google Scholar 

  16. Babbush CA, Kevy SV, Jacobson MS. An in vitro and in vivo evaluation of autologous platelet concentrate in oral reconstruction. Implant Dent. 2003;12(1):24–34.

    Article  PubMed  Google Scholar 

  17. Garrick J. Characterization of the patient population in a sports medicine facility. Phys Sports Med. 1985;13:73–6.

    Article  CAS  Google Scholar 

  18. Pardon E. Lower extremities are the site of most soccer injuries. Phys Sports Med. 1977;5:43–8.

    Article  CAS  Google Scholar 

  19. Backx FJ, Erich WB, Kemper AB, Verbeek AL. Sports injuries in school-aged children. An epidemiologic study. Am J Sports Med. 1989;17(2):234–40.

    Article  CAS  PubMed  Google Scholar 

  20. Garrick JG, Requa RK. The epidemiology of foot and ankle injuries in sports. Clin Sports Med. 1988;7(1):29–36.

    CAS  PubMed  Google Scholar 

  21. Schafle MD, Requa RK, Patton WL, Garrick JG. Injuries in the 1987 national amateur volleyball tournament. Am J Sports Med. 1990;18(6):624–31.

    Article  CAS  PubMed  Google Scholar 

  22. Smith LS, Clarke TE, Hamill CL, Santopietro F. The effects of soft and semi-rigid orthoses upon rearfoot movement in running. J Am Podiatr Med Assoc. 1986;76(4):227–33.

    Article  CAS  PubMed  Google Scholar 

  23. Watson AW. Sports injuries during one academic year in 6799 Irish school children. Am J Sports Med. 1984;12(1):65–71.

    Article  CAS  PubMed  Google Scholar 

  24. DeHaven KE, Lintner DM. Athletic injuries: comparison by age, sport, and gender. Am J Sports Med. 1986;14(3):218–24.

    Article  CAS  PubMed  Google Scholar 

  25. Kannus P, Aho H, Jarvinen M, Niittymaki S. Computerized recording of visits to an outpatient sports clinic. Am J Sports Med. 1987;15(1):79–85.

    Article  CAS  PubMed  Google Scholar 

  26. Kvist M, Kujala UM, Heinonen OJ, et al. Sports-related injuries in children. Int J Sports Med. 1989;10(2):81–6.

    Article  CAS  PubMed  Google Scholar 

  27. Zaricznyj B, Shattuck LJ, Mast TA, Robertson RV, D’Elia G. Sports-related injuries in school-aged children. Am J Sports Med. 1980;8(5):318–24.

    Article  CAS  PubMed  Google Scholar 

  28. Nelson AJ, Collins CL, Yard EE, Fields SK, Comstock RD. Ankle injuries among United States high school sports athletes, 2005-2006. J Athl Train. 2007;42(3):381–7.

    PubMed  PubMed Central  Google Scholar 

  29. Koutures CG, Gregory AJ. Injuries in youth soccer. Pediatrics. 2010;125(2):410–4.

    Article  PubMed  Google Scholar 

  30. Perlman M, Leveille D, DeLeonibus J, et al. Inversion lateral ankle trauma: differential diagnosis, review of the literature, and prospective study. J Foot Surg. 1987;26(2):95–135.

    CAS  PubMed  Google Scholar 

  31. Boden SD, Labropoulos PA, McCowin P, Lestini WF, Hurwitz SR. Mechanical considerations for the syndesmosis screw. A cadaver study. J Bone Joint Surg Am. 1989;71(10):1548–55.

    CAS  PubMed  Google Scholar 

  32. Ebraheim NA, Elgafy H, Padanilam T. Syndesmotic disruption in low fibular fractures associated with deltoid ligament injury. Clin Orthop Relat Res. 2003;409:260–7.

    Article  PubMed  Google Scholar 

  33. Muir DC, Amendola A, Saltzman CL. Long-term outcome of ankle arthrodesis. Foot Ankle Clin. 2002;7(4):703–8.

    Article  PubMed  Google Scholar 

  34. Skinner HB. Current diagnosis & treatment in orthopedics. 3rd ed. New York: Lange Medical Books/McGraw-Hill; 2003.

    Google Scholar 

  35. DeLee J, Drez D, Miller MD. DeLee & Drez’s orthopaedic sports medicine: principles and practice. 3rd ed. Philadelphia: Saunders/Elsevier; 2010.

    Google Scholar 

  36. Oprea WE, Karp JM, Hosseini MM, Davies JE. Effect of platelet releasate on bone cell migration and recruitment in vitro. J Craniofac Surg. 2003;14(3):292–300.

    Article  PubMed  Google Scholar 

  37. Kanno T, Takahashi T, Tsujisawa T, Ariyoshi W, Nishihara T. Platelet-rich plasma enhances human osteoblast–like cell proliferation and differentiation. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2005;63(3):362–9.

    Article  Google Scholar 

  38. Kruger JP, Hondke S, Endres M, Pruss A, Siclari A, Kaps C. Human platelet-rich plasma stimulates migration and chondrogenic differentiation of human subchondral progenitor cells. J Orthop Res Off Publ Orthop Res Soc. 2012;30(6):845–52.

    Article  Google Scholar 

  39. Carofino B, Chowaniec DM, McCarthy MB, et al. Corticosteroids and local anesthetics decrease positive effects of platelet-rich plasma: an in vitro study on human tendon cells. Arthroscopy J Arthroscop Relat Surg Off Publ Arthroscopy Assoc North Am Int Arthroscopy Assoc. 2012;28(5):711–9.

    Article  Google Scholar 

  40. Gandhi A, Doumas C, O’Connor JP, Parsons JR, Lin SS. The effects of local platelet rich plasma delivery on diabetic fracture healing. Bone. 2006;38(4):540–6.

    Article  CAS  PubMed  Google Scholar 

  41. Nather A, Wong KL, David V, Pereira BP. Allografts with autogenous platelet-rich plasma for tibial defect reconstruction: a rabbit study. J Orthop Surg (Hong Kong). 2012;20(3):375–80.

    Google Scholar 

  42. Chen L, Dong SW, Liu JP, Tao X, Tang KL, Xu JZ. Synergy of tendon stem cells and platelet-rich plasma in tendon healing. J Orthop Res Off Publ Orthop Res Soc. 2012;30(6):991–7.

    Article  CAS  Google Scholar 

  43. Mifune Y, Matsumoto T, Takayama K, et al. The effect of platelet-rich plasma on the regenerative therapy of muscle derived stem cells for articular cartilage repair. Osteoarthritis Cartilage/OARS Osteoarthritis Res Soc. 2013;21(1):175–85.

    Article  CAS  Google Scholar 

  44. Gandhi A, Berberian W. Platelet release enhances healing in patients with a non union. Paper presented at: ORS 49th annual meeting. New Orleans; 2003.

    Google Scholar 

  45. Bibbo C, Bono CM, Lin SS. Union rates using autologous platelet concentrate alone and with bone graft in high-risk foot and ankle surgery patients. J Surg Orthop Adv. 2005;14(1):17–22.

    PubMed  Google Scholar 

  46. Barrow CR, Pomeroy GC. Enhancement of syndesmotic fusion rates in total ankle arthroplasty with the use of autologous platelet concentrate. Foot Ankle Int/Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc. 2005;26(6):458–61.

    Google Scholar 

  47. Coetzee JC, Pomeroy GC, Watts JD, Barrow C. The use of autologous concentrated growth factors to promote syndesmosis fusion in the Agility total ankle replacement. A preliminary study. Foot Ankle Int/Am Orthop Foot Ankle Soc Swiss Foot Ankle Soc. 2005;26(10):840–6.

    Google Scholar 

  48. Wei LC, Lei GH, Sheng PY, et al. Efficacy of platelet-rich plasma combined with allograft bone in the management of displaced intra-articular calcaneal fractures: a prospective cohort study. J Orthop Res Off Publ Orthop Res Soc. 2012;30(10):1570–6.

    Article  Google Scholar 

  49. Sanchez M, Anitua E, Azofra J, Andia I, Padilla S, Mujika I. Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med. 2007;35(2):245–51.

    Article  PubMed  Google Scholar 

  50. Schepull T, Kvist J, Norrman H, Trinks M, Berlin G, Aspenberg P. Autologous platelets have no effect on the healing of human achilles tendon ruptures: a randomized single-blind study. Am J Sports Med. 2011;39(1):38–47.

    Article  PubMed  Google Scholar 

  51. Gaweda K, Tarczynska M, Krzyzanowski W. Treatment of Achilles tendinopathy with platelet-rich plasma. Int J Sports Med. 2010;31(8):577–83.

    Article  CAS  PubMed  Google Scholar 

  52. Delos D, Murawski C, Kennedy J. Platelet-rich plasma for foor and ankle disorders in the athletic population. Tech Foot Ankle Surg. 2011;10:11–7.

    Article  Google Scholar 

  53. Monto RR. Platelet rich plasma treatment for chronic Achilles tendinosis. Foot Ankle Int/Am Orthop Foot Ankle Soc [and] Swiss Foot Ankle Soc. 2012;33(5):379–85.

    Article  Google Scholar 

  54. Sánchez M, Anitua E, Cole A, Da Silva A, Azofra J, Andia I. Management of post-surgical Achilles tendon complications with a preparation rich in growth factors: A study of two-cases. Injury Extra. 2009;40:11–5.

    Article  Google Scholar 

  55. de Vos RJ, Weir A, Tol JL, Verhaar JA, Weinans H, van Schie HT. No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy. Br J Sports Med. 2011;45(5):387–92.

    Article  PubMed  Google Scholar 

  56. de Vos RJ, Weir A, van Schie HT, et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303(2):144–9.

    Article  PubMed  Google Scholar 

  57. Owens Jr RF, Ginnetti J, Conti SF, Latona C. Clinical and magnetic resonance imaging outcomes following platelet rich plasma injection for chronic midsubstance Achilles tendinopathy. Foot Ankle Int/Am Orthop Foot Ankle Society [and] Swiss Foot Ankle Soc. 2011;32(11):1032–9.

    Article  Google Scholar 

  58. Martinelli N, Marinozzi A, Carni S, Trovato U, Bianchi A, Denaro V. Platelet-rich plasma injections for chronic plantar fasciitis. Int Orthop. 2012;37(5):839–42.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Ragab EM, Othman AM. Platelets rich plasma for treatment of chronic plantar fasciitis. Arch Orthop Trauma Surg. 2012;132(8):1065–70.

    Article  PubMed  Google Scholar 

  60. Aksahin E, Dogruyol D, Yuksel HY, et al. The comparison of the effect of corticosteroids and platelet-rich plasma (PRP) for the treatment of plantar fasciitis. Arch Orthop Trauma Surg. 2012;132(6):781–5.

    Article  PubMed  Google Scholar 

  61. Mei-Dan O, Carmont MR, Laver L, Mann G, Maffulli N, Nyska M. Platelet-rich plasma or hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med. 2012;40(3):534–41.

    Article  PubMed  Google Scholar 

  62. Sheth U, Simunovic N, Klein G, et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am. 2012;94(4):298–307.

    Article  PubMed  Google Scholar 

  63. Han B, Woodell-May J, Ponticiello M, Yang Z, Zimni M. The effect of thrombin activation of platelet-rich plasma on demineralized bone matrix osteoinductivity. J Bone Joint Surg Am. 2009;91(6):1459–70.

    Article  PubMed  Google Scholar 

  64. Harrison S, Vavken P, Kevy S, Jacobson M, Zurakowski D, Murray MM. Platelet activation by collagen provides sustained release of anabolic cytokines. Am J Sports Med. 2011;39(4):729–34.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Visser LC, Arnoczky SP, Caballero O, Egerbacher M. Platelet-rich fibrin constructs elute higher concentrations of transforming growth factor-beta1 and increase tendon cell proliferation over time when compared to blood clots: a comparative in vitro analysis. Veterinary Surg VS. 2010;39(7):811–7.

    Article  PubMed  Google Scholar 

  66. Kevy SV, Jacobson MS. Comparison of methods for point of care preparation of autologous platelet gel. J Extra Corpor Technol. 2004;36(1):28–35.

    PubMed  Google Scholar 

  67. Weibrich G, Kleis WK, Streckbein P, Moergel M, Hitzler WE, Hafner G. Comparison of point-of-care methods for preparation of platelet concentrate (platelet-rich plasma). Int J Oral Maxillofac Implants. 2012;27(4):762–9.

    PubMed  Google Scholar 

  68. Landesberg R, Moses M, Karpatkin M. Risks of using platelet rich plasma gel. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 1998;56(9):1116–7.

    Article  CAS  Google Scholar 

  69. Tamimi FM, Montalvo S, Tresguerres I, Blanco JL. A comparative study of 2 methods for obtaining platelet-rich plasma. J Oral Maxillofac Surg Off J Am Assoc Oral Maxillofac Surg. 2007;65(6):1084–93.

    Article  Google Scholar 

  70. Mazzocca AD, McCarthy MB, Chowaniec DM, et al. Platelet-rich plasma differs according to preparation method and human variability. J Bone Joint Surg Am. 2012;94(4):308–16.

    Article  PubMed  Google Scholar 

  71. Castillo TN, Pouliot MA, Kim HJ, Dragoo JL. Comparison of growth factor and platelet concentration from commercial platelet-rich plasma separation systems. Am J Sports Med. 2011;39(2):266–71.

    Article  PubMed  Google Scholar 

  72. Weibrich G, Kleis WK, Hafner G, Hitzler WE, Wagner W. Comparison of platelet, leukocyte, and growth factor levels in point-of-care platelet-enriched plasma, prepared using a modified Curasan kit, with preparations received from a local blood bank. Clin Oral Implants Res. 2003;14(3):357–62.

    Article  PubMed  Google Scholar 

  73. Weibrich G, Kleis WK, Hitzler WE, Hafner G. Comparison of the platelet concentrate collection system with the plasma-rich-in-growth-factors kit to produce platelet-rich plasma: a technical report. Int J Oral Maxillofac Implants. 2005;20(1):118–23.

    PubMed  Google Scholar 

  74. Tidball JG. Inflammatory processes in muscle injury and repair. Am J Physiol Regul Integr Comp Physiol. 2005;288(2):R345–353.

    Article  CAS  PubMed  Google Scholar 

  75. McCarrel T, Fortier L. Temporal growth factor release from platelet-rich plasma, trehalose lyophilized platelets, and bone marrow aspirate and their effect on tendon and ligament gene expression. J Orthop Res Off Publ Orthop Res Soc. 2009;27(8):1033–42.

    Article  CAS  Google Scholar 

  76. Dragoo JL, Braun HJ, Durham JL, et al. Comparison of the acute inflammatory response of two commercial platelet-rich plasma systems in healthy rabbit tendons. Am J Sports Med. 2012;40(6):1274–81.

    Article  PubMed  Google Scholar 

  77. McCarrel TM, Minas T, Fortier LA. Optimization of leukocyte concentration in platelet-rich plasma for the treatment of tendinopathy. J Bone Joint Surg Am Vol. 2012;94(19):e143(141–148).

    Google Scholar 

  78. Mazzocca AD, McCarthy MB, Chowaniec DM, et al. The positive effects of different platelet-rich plasma methods on human muscle, bone, and tendon cells. Am J Sports Med. 2012;40(8):1742–9.

    Article  PubMed  Google Scholar 

  79. Nikolidakis D, van den Dolder J, Wolke JG, Stoelinga PJ, Jansen JA. The effect of platelet-rich plasma on the bone healing around calcium phosphate-coated and non-coated oral implants in trabecular bone. Tissue Eng. 2006;12(9):2555–63.

    Article  CAS  PubMed  Google Scholar 

  80. Zechner W, Tangl S, Tepper G, et al. Influence of platelet-rich plasma on osseous healing of dental implants: a histologic and histomorphometric study in minipigs. Int J Oral Maxillofac Implants. 2003;18(1):15–22.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Rutgers Medical school, 185 South Orange Avenue, Newark, 07103, NJ, USA

    Catie Cunningham MD, Amit Sood MD & Sheldon Lin MD

Authors
  1. Catie Cunningham MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Amit Sood MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sheldon Lin MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Sheldon Lin MD .

Editor information

Editors and Affiliations

  1. Department of Musculoskeletal Disorders Faculty of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy

    Nicola Maffulli

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer-Verlag London

About this chapter

Cite this chapter

Cunningham, C., Sood, A., Lin, S. (2016). Platelet Rich Plasma in Foot and Ankle Surgery. In: Maffulli, N. (eds) Platelet Rich Plasma in Musculoskeletal Practice. Springer, London. https://doi.org/10.1007/978-1-4471-7271-0_7

Download citation

  • DOI: https://doi.org/10.1007/978-1-4471-7271-0_7

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-1-4471-7270-3

  • Online ISBN: 978-1-4471-7271-0

  • eBook Packages: Medicine

Publish with us

Policies and ethics

Search

Navigation