Abstract
Purpose of Review
This review discusses the current literature regarding the use of platelet-rich plasma (PRP) in the treatment of muscle strain injuries. Case series as well as experimental trials for both human and animal models are covered.
Recent Findings
Multiple studies have examined outcomes for the use of PRP in the treatment of muscle strain injuries. PRP has been shown to promote muscle recovery via anabolic growth factors released from activated platelets, and in doing so, potentially reduces pain, swelling, and time for return to play.
Summary
In vitro studies support the regenerative potential of PRP for acute soft tissue injuries. Multiple clinical case series for PRP injections in the setting of muscle strains demonstrate imaging evidence for faster healing, less swelling, which can decrease time for return to play. These studies, however, are retrospective in nature, and few randomized controlled studies exist to demonstrate a clear clinical benefit. Additionally, there is tremendous heterogeneity regarding the injectant preparation, optimum platelet concentration, presence of leukocytes, and volume of PRP which should be administered as well as number of and timing of treatments.
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References
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• Sheth U, Dwyer T, Smith I, Wasserstein D, Theodoropoulos J, Takhar S, et al. Does platelet-rich plasma lead to earlier return to sport when compared with conservative treatment in acute muscle injuries? a systematic review and meta-analysis. Arthroscopy. 2018;34(1):281–8. This study aimed to compare the time to return to sport and reinjury rate after PRP injection versus control in patients with acute grade I or II muscle strains. The primary outcome was time to return to play while the secondary outcome was the rate of reinjury at a minimum of 6 months. Subgroup analysis was performed to examine efficacy of PRP in hamstring muscle strain individually. Five randomized controlled trials which included a total of 268 patients with grade I and II acute muscle injuries were eligible review. Two-hundred twenty-two of 268 patients were reported to be competitive athletes. Two studies described PRP usage with the GPSIII system (Biomet Biologics), whereas one study used the autologous conditioned plasma (Arthrex), and the remaining two studies did not report which system was used. Platelet concentration ranged from 443 to 1297 × 10 3 /μL and there was considerable variability in injection protocols, ranging from a single 3-mL injection to 5-mL injection to a multiple 3-mL injection protocol. Control groups were treated with a daily home exercise program with progressive agility and trunk stabilization in conjunction with 1, 2, or 3 physiotherapy sessions, while one study had a control group with blinded placebo (normal saline) injection. The pooled results demonstrated a significantly earlier return to sport for the PRP group when compared to control with a mean difference of 5.57 days earlier return to play with PRP. Subgroup analysis showed no difference in time to return to sport when comparing PRP and control for treatment of grade I and II hamstring muscle strains alone. No significant reinjury rate was found between two groups at a 6-month follow-up. The study suggested that the use of PRP for acute grade I and II muscle strains may result in faster return to sport without increasing the rate of reinjury; however, no difference was noted in time to return to sport looking at acute grade I and II hamstring strains specifically.
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• Hamilton B, Tol JL, Almusa E, Boukarroum S, Eirale C, Farooq A, et al. Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomized controlled trial. Br J Sports Med. 2015;49:943–50. This study looked at the efficacy of a single PRP injection in reducing the return to sport duration in male athletes after acute hamstring injury. The study is a randomized, three-arm, double-blind, parallel-group trial including 90 professional athletes with hamstring injuries confirmed on MRI. Patients were randomized to PRP, PPP (platelet-poor plasma) or control (no injection) groups. All patients received intensive standardized rehabilitation and the primary outcome measure was return to play, with secondary outcome measures including reinjury rate after 2 and 6 months. The adjusted time to return to sport was − 5.7 days between PRP and PPP which was significant ( p = 0.01); however, the adjusted time to return to sport between PRP and control was − 2.9 days, which was not significant ( p = 0.189). The time to return to sport between PPP and control was 2.8 days, which was not significant ( p = 0.210). There was no difference in reinjury rate between any groups. In conclusion, this study found that there was no benefit of a single PRP injection over rehabilitation program in athletes who have sustained acute MRI positive hamstring injuries.
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• Grassi A, Napoli F, Romandini I, Samuelsson K, Zaffagnini S, Candrian C, et al. Platelet-rich plasma (PRP) effective in the treatment of acute muscle injuries? a systematic review and meta-analysis. Sports Med. 2018;48(4):971–89. This study was a meta-analysis of randomized controlled trials looking to evaluate the effect of PRP injections on outcomes following acute muscle injuries. They included randomized controlled trials which investigated the effect of PRP for the treatment of acute muscle injuries against at least one control group, encompassing placebo injection or physical therapy. The outcomes evaluated were time to return to sport, reinjuries, complications, pain, muscle strength, range of motion and flexibility, muscle function, and imaging. Six studies were included with a total of 374 patients. Time to return to sport was significantly shorter in patients treated with PRP (mean difference − 7.17 days), but if only double-blind studies or studies or studies involving only hamstring injuries were analyzed, non-significant differences were found. The rate of reinjury and complications was similar between the two groups ( p > 0.05), nor was any differences in pain, muscle strength, flexibility muscle function, and imaging. The authors did note that the performance bias was a high risk due to lack of blinding in four studies. Due to the bias in the studies, heterogeneity of the findings, and limited sample size, the authors found that the evidence should be considered a low quality despite promising biological rationale, positive preclinical findings, and early successful clinical experience of PRP.
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Setayesh, K., Villarreal, A., Gottschalk, A. et al. Treatment of Muscle Injuries with Platelet-Rich Plasma: a Review of the Literature. Curr Rev Musculoskelet Med 11, 635–642 (2018). https://doi.org/10.1007/s12178-018-9526-8
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DOI: https://doi.org/10.1007/s12178-018-9526-8