Platelet-rich plasma in tendon-related disorders: results and indications
- 2.3k Downloads
Platelet-rich plasma (PRP) is currently the most exploited strategy in the clinical practice to provide a regenerative stimulus for tendon healing. The aim of the present study was to systematically review the available evidence on the treatment of the main tendon disorders where PRP is currently applied.
A systematic review of the literature was performed on the use of PRP as a treatment for tendinopathies focusing on the following sites: Achilles tendon, patellar tendon, rotator cuff tendons, and lateral elbow tendons. The following inclusion criteria for relevant articles were used: clinical trials written in English language up to 21 June 2016 on the use of PRP in the conservative or surgical treatment of the aforementioned tendinopathies.
The research identified the following clinical trials dealing with the application of PRP in the selected tendons: 19 papers on patellar tendon (6 being RCTs: 4 dealing with PRP conservative application and 2 surgical), 24 papers on Achilles tendon (4 RCTs: 3 conservative and 1 surgical), 29 on lateral elbow tendons (17 RCTs, all conservative), and 32 on rotator cuff (22 RCTs: 18 surgical and 3 conservative).
Patellar tendons seem to benefit from PRP injections, whereas in the Achilles tendon, PRP application is not indicated neither as a conservative approach nor as a surgical augmentation. Lateral elbow tendinopathy showed an improvement in most of the high-level studies, but the lack of proven superiority with respect to the more simple whole-blood injections still questions its use in the clinical practice. With regard to rotator cuff pathology, the vast majority of surgical RCTs documented a lack of beneficial effects, whereas there is still inconclusive evidence concerning its conservative application in rotator cuff disorders.
Level of evidence
Systematic review of level I–IV trials, Level IV.
KeywordsPRP Achilles tendon Patellar tendon Rotator cuff Lateral elbow Tendinopathy Growth factors Review
The present study was partially supported by PRRU (Emilia-Romagna Region/University of Bologna Project) 2010–2012.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
There is no funding source.
This article does not contain any studies with human participants or animals performed by any of the authors.
For this kind of study (systematic review of literature) formal consent is not required.
- 14.Creaney L, Wallace A, Curtis M et al (2011) Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med 45(12):966–971PubMedCrossRefGoogle Scholar
- 26.Dohan Ehrenfest DM, Bielecki T, Jimbo R et al (2012) Do the fibrin architecture and leukocyte content influence the growth factor release of platelet concentrates? An evidence-based answer comparing a pure platelet-rich plasma (P-PRP) gel and a leukocyte- and platelet-rich fibrin (L-PRF). Curr Pharm Biotechnol 13(7):1145–1152PubMedCrossRefGoogle Scholar
- 45.Hak A, Rajaratnam K, Ayeni OR et al (2015) A double-blinded placebo randomized controlled trial evaluating short-term efficacy of platelet-rich plasma in reducing postoperative pain after arthroscopic rotator cuff repair: a pilot study. Sports Health. 7(1):58–66PubMedPubMedCentralCrossRefGoogle Scholar
- 72.Montalvan B, Le Goux P, Klouche S et al (2016) Inefficacy of ultrasound-guided local injections of autologous conditioned plasma for recent epicondylitis: results of a double-blind placebo-controlled randomized clinical trial with one-year follow-up. Rheumatology (Oxford) 55(2):279–285CrossRefGoogle Scholar
- 75.Oloff L, Elmi E, Nelson J, Crain J (2015) Retrospective analysis of the effectiveness of platelet-rich plasma in the treatment of Achilles tendinopathy: pretreatment and posttreatment correlation of magnetic resonance imaging and clinical assessment. Foot Ankle Spec. 8(6):490–497PubMedCrossRefGoogle Scholar
- 78.Pandey V, Bandi A, Madi S et al (2016) Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. J Shoulder Elbow Surg. doi: 10.1016/j.jse.2016.01.036 CrossRefPubMedGoogle Scholar
- 79.Peerbooms JC, Sluimer J, Bruijn DJ et al (2010) Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med 38(2):255–262PubMedCrossRefGoogle Scholar
- 91.Salini V, Vanni D, Pantalone A et al (2015) Platelet Rich Plasma therapy in non-insertional Achilles tendinopathy: the efficacy is reduced in 60-years old people compared to young and middle-age individuals. Front Aging Neurosci. 10(7):228Google Scholar
- 102.Tschon M, Fini M, Giardino R et al (2011) Lights and shadows concerning platelet products for musculoskeletal regeneration. Front Biosci (Elite Ed). 1(3):96–107Google Scholar
- 117.Zumstein MA, Rumian A, Lesbats V et al (2014) Increased vascularization during early healing after biologic augmentation in repair of chronic rotator cuff tears using autologous leukocyte- and platelet-rich fibrin (L-PRF): a prospective randomized controlled pilot trial. J Shoulder Elbow Surg 23(1):3–12PubMedCrossRefGoogle Scholar