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Clinical Applications of PRP: Musculoskeletal Applications, Current Practices and Update

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  • Musculoskeletal Interventions
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Abstract

Musculoskeletal tissues are often subjected to deleterious effects stemming from traumatic injuries or degenerative pathologies, which can impede the body’s natural repair response. The advent of regenerative medicine has emerged as a promising therapeutic approach in modern patient care. Among the interventions in this cutting-edge field, platelet-rich plasma (PRP) and cell-based therapies, such as mesenchymal stem cells, have garnered significant attention. In this article, we endeavor to provide an overview of the current practices and recent developments in PRP therapy, with a particular emphasis on the clinical applications for musculoskeletal pathologies.

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References

  1. Everts P, Onishi K, Jayaram P, Lana JF, Mautner K. Platelet-rich plasma: new performance understandings and therapeutic considerations in 2020. Int J Mol Sci. 2020;21(20):7794. https://doi.org/10.3390/ijms21207794.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Mathew J, Sankar P, Varacallo M. Physiology, Blood plasma. 2022 Apr 28. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022; PMID: 30285399.

  3. Gremmel T, Frelinger AL 3rd, Michelson AD. Platelet physiology. Semin Thromb Hemost. 2016;42(3):191–204. https://doi.org/10.1055/s-0035-1564835. (Epub 2016 Feb 29 PMID: 26926581).

    Article  CAS  PubMed  Google Scholar 

  4. Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10:225–8.

    Article  CAS  PubMed  Google Scholar 

  5. Rand E, Gellhorn AC. The healing cascade: facilitating and optimizing the system. Phys Med Rehabil Clin N Am. 2016;27(4):765–81.

    Article  PubMed  Google Scholar 

  6. Lyras DN, Kazakos K, Verettas D, et al. The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing. Foot Ankle Int. 2009;30:1101–6.

    Article  PubMed  Google Scholar 

  7. Dhurat R, Sukesh M. Principles and methods of preparation of platelet-rich plasma: a review and author’s perspective. J Cutan Aesthet Surg. 2014;7(4):189–97.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J Bone and Jt Surg. 2009;91(8):987–96.

    Article  CAS  Google Scholar 

  9. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med. 2009;37(11):2259–72.

    Article  PubMed  Google Scholar 

  10. Mautner K, Malanga GA, Smith J, Shiple B, Ibrahim V, Sampson S, Bowen JE. A call for a standard classification system for future biologic research: the rationale for new PRP nomenclature. PM&R. 2015;7(4 Suppl):S53–9.

    Google Scholar 

  11. Fitzpatrick J, Bulsara MK, O’Donnell J. The effectiveness of platelet-rich plasma injections in gluteal tendinopathy: a randomized, double-blind controlled trial comparing a single platelet-rich plasma injection with a single corticosteroid injection. Am J Sports Med. 2017;45(9):2150–7.

    Google Scholar 

  12. Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA. Platelet-rich plasma: a milieu of bioactive factors. Arthroscopy. 2012;28(3):429–39.

    Article  PubMed  Google Scholar 

  13. Giusti I, Di Francesco M, D’Ascenzo S, et al. Leukocyte depletion does not affect the in vitro healing ability of platelet rich plasma. Exp Ther Med. 2018;15(4):4029–38.

    CAS  PubMed  PubMed Central  Google Scholar 

  14. Sundman EA, Cole BJ, Fortier LA. Growth factor and catabolic cytokine concentrations are influenced by the cellular composition of platelet-rich plasma. Am J Sports Med. 2011;39(10):2135–40.

    Article  PubMed  Google Scholar 

  15. Harrison P. Subcommittee on platelet physiology The use of platelets in regenerative medicine and proposal for a new classification system: guidance from the SSC of the ISTH. J Thromb Haemost. 2018;16(9):1895–900. https://doi.org/10.1111/jth.14223. (Epub 2018 Aug 11 PMID: 30099839).

    Article  CAS  PubMed  Google Scholar 

  16. Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost. 2004;91(1):4–15.

    Article  CAS  PubMed  Google Scholar 

  17. Mazzocca AD, McCarthy MB, Chowaniec DM, Cote MP, Romeo AA, Bradley JP, Arciero RA. Platelet-rich plasma differs according to preparation method and human variability. J Bone Jt Surg. 2012;94(4):308–16.

    Article  Google Scholar 

  18. Magalon J, Chateau AL, Bertrand B, Louis ML, Silvestre A, Giraudo L, Sabatier F. DEPA classification: a proposal for standardising PRP use and a retrospective application of available devices. BMJ Open Sport Exercise Med. 2016;2(1):e000060.

    Article  CAS  Google Scholar 

  19. Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol. 2009;27(3):158–67.

    Article  CAS  PubMed  Google Scholar 

  20. Sundman EA, Cole BJ, Karas V. The anti-inflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med. 2011;39(1):43–52.

    Google Scholar 

  21. Andia I, Maffulli N. Platelet-rich plasma for managing pain and inflammation in osteoarthritis. Nat Rev Rheumatol. 2018;14(12):721–30.

    Article  Google Scholar 

  22. Hamid A, Shariff M, Yusof A, Ali MRM. Platelet-rich plasma (PRP) for acute muscle injury: a systematic review. PLoS ONE. 2014;9(2):e90538.

    Article  PubMed  Google Scholar 

  23. Chen X, Jones IA, Park C, Vangsness CT. The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. Am J Sports Med. 2018;46(8):2020–32. https://doi.org/10.1177/0363546517743746.

    Article  PubMed  Google Scholar 

  24. Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. 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. 2010;38(2):255–62. https://doi.org/10.1177/0363546509355445.

    Article  PubMed  Google Scholar 

  25. Hurley ET, Hannon CP, Pauzenberger L, Fat DL, Moran CJ, Mullett H. Nonoperative treatment of rotator cuff disease with platelet-rich plasma: a systematic review of randomized controlled trials. Arthroscopy The Journal of Arthroscopic & Related Surgery. 2019;35(5):1584–91. https://doi.org/10.1016/j.arthro.2018.11.065.

    Article  Google Scholar 

  26. Milgrom C, Novack V, Weil Y, et al. Risk factors for idiopathic frozen shoulder. Isr Med Assoc J. 2008;10:361–4.

    PubMed  Google Scholar 

  27. In M-T, Wei K-C, Wu C-H. Effectiveness of platelet-rich plasma injection in rotator cuff tendinopathy: a systematic review and meta-analysis of randomized controlled trials. Diagnostics. 2020;10:189. https://doi.org/10.3390/diagnostics10040189.

    Article  CAS  Google Scholar 

  28. Barman A, Mukherjee S, Sahoo J, et al. Single intra-articular platelet-rich plasma versus corticosteroid injections in the treatment of adhesive capsulitis of the shoulder: a cohort study. Am J Phys Med Rehabil. 2019;98:549–57.

    Article  PubMed  Google Scholar 

  29. Akşahin E, 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 

  30. Shetty SH, et al. Platelet-rich plasma has better long-term results than corticosteroids or placebo for chronic plantar fasciitis: randomized control trial. J Foot Ankle Surg. 2019;58(1):42–6.

    Article  PubMed  Google Scholar 

  31. Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006;34(11):1774–8. https://doi.org/10.1177/0363546506288850.

    Article  PubMed  Google Scholar 

  32. Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011;39(6):1200–8. https://doi.org/10.1177/0363546510397173.

    Article  PubMed  Google Scholar 

  33. Chou LC, Liou TH, Kuan YC, Huang YH, Chen HC. Autologous blood-derived products compared with corticosteroids for treatment of plantar fasciopathy or tendinopathy: A systematic review and meta-analysis of randomized controlled trials. Arch Phys Med Rehabil. 2020;101(2):329–43. https://doi.org/10.1016/j.apmr.2019.08.475.

    Article  Google Scholar 

  34. Virchenko O, Aspenberg P. How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks?: Interplay between early regeneration and mechanical stimulation. Acta Orthop. 2006;77(5):806–12.

    Article  PubMed  Google Scholar 

  35. Hurley ET, Shimozono Y, Hannon CP, Smyth NA, Murawski CD, Kennedy JG. Platelet-rich plasma versus corticosteroids for plantar fasciitis: a systematic review of randomized controlled trials. Orthop J Sports Med. 2020;8(4):2325967120915704. https://doi.org/10.1177/2325967120915704.PMID:32426407;PMCID:PMC7222276.

    Article  PubMed  PubMed Central  Google Scholar 

  36. de Vos RJ, Weir A, van Schie HTM, Bierma-Zeinstra SMA, Verhaar JAN, Weinans H, Tol JL. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010;303(2):144–9. https://doi.org/10.1001/jama.2009.1986.

    Article  PubMed  Google Scholar 

  37. Zhang YJ, Xu SZ, Gu PC, Du JY, Cai YZ, Zhang C, Lin XJ. Is Platelet-rich plasma injection effective for chronic achilles tendinopathy? a meta-analysis. Clin Orthop Relat Res. 2016;474(8):1640–51. https://doi.org/10.1007/s11999-016-4848-y.

    Article  Google Scholar 

  38. Filardo G, et al. Platelet-rich plasma injections for the treatment of refractory Achilles tendinopathy: results at 4 years. Blood transfus Trasfus del sang. 2014;12(4):533–40. https://doi.org/10.2450/2014.0289-13.

    Article  Google Scholar 

  39. Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J Bone Joint Surg Br. 2009;91:987–96.

    Article  CAS  PubMed  Google Scholar 

  40. McCrum CL, et al. Return to play after PRP and rehabilitation of 3 elite ice hockey players with ulnar collateral ligament injuries of the elbow. Orthop J Sports Med. 2018;6(8):2325967118790760.

    PubMed  PubMed Central  Google Scholar 

  41. Bradley JP, et al. Platelet-rich plasma shortens return to play in National Football League players with acute hamstring injuries. Orthop J Sports Med. 2020;8(4):2325967120911731.

    PubMed  PubMed Central  Google Scholar 

  42. Hamilton B, et al. Platelet-rich plasma does not enhance return to play in hamstring injuries: a randomised controlled trial. Br J Sports Med. 2015;49(14):943–50.

    Article  PubMed  Google Scholar 

  43. Lundblad M, et al. Medial collateral ligament injuries of the knee in male professional football players: a prospective three-season study of 130 cases from the UEFA Elite Club Injury Study. Knee Surg Sports Traumatol Arthros. 2019;27(11):3692–8.

    Article  Google Scholar 

  44. Mills FB, Misra AK, Goyeneche N, Hackel JG, Andrews JR, Joyner PW. Return to play after platelet-rich plasma injection for elbow UCL injury: outcomes based on injury severity. Orthop J Sports Med. 2021. https://doi.org/10.1177/2325967121991135.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Moraes, V. Y., Lenza, M., Tamaoki, M. J., Faloppa, F., & Belloti, J. C. Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database of Systematic Reviews. 2013; 4.

  46. Shen L, et al. The temporal effect of platelet-rich plasma on pain and physical function in the treatment of knee osteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2017;12(1):16.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Dai WL, et al. Efficacy of platelet-rich plasma in the treatment of knee osteoarthritis: a meta-analysis of randomized controlled trials. Arthroscopy. 2017;33(3):659–70.

    Article  PubMed  Google Scholar 

  48. Laudy AB, et al. Efficacy of platelet-rich plasma injections in osteoarthritis of the knee: a systematic review and meta-analysis. Br J Sports Med. 2015;49(10):657–72.

    Article  PubMed  Google Scholar 

  49. Son S-R, Sarkar SK, Nguyen-Thuy BL, Padalhin AR, Kim BR, Jung HI, et al. Platelet-rich plasma encapsulation in hyaluronic acid/gelatin-BCP hydrogel for growth factor delivery in BCP sponge scaffold for bone regeneration. J Biomater Appl. 2015;29:988–1002.

    Article  PubMed  Google Scholar 

  50. Dallari D, Stagni C, Rani N, Sabbioni G, Pelotti P, Torricelli P, et al. Ultrasound-guided injection of platelet-rich plasma and hyaluronic acid, separately and in combination, for hip osteoarthritis: a randomized controlled study. Am J Sports Med. 2016;44:664–71.

    Article  PubMed  Google Scholar 

  51. Lana JFSD, Weglein A, Sampson SE, Vicente EF, Huber SC, Souza CV, et al. Randomized controlled trial comparing hyaluronic acid, platelet-rich plasma and the combination of both in the treatment of mild and moderate osteoarthritis of the knee. J Stem Cells Regen Med. 2016;12:69–78.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Rabago D, Best TM, Zgierska AE, Zeisig E, Ryan M, Crane D. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood, and platelet-rich plasma. Br J Sports Med. 2013;47(12):792–800.

    Google Scholar 

  53. Rahimzadeh P, Imani F, Faiz SH, Entezary SR, Nasiri AA, Ziaeefard M. Investigation the efficacy of intra-articular prolotherapy with erythropoietin and dextrose and intra-articular pulsed radiofrequency on pain level reduction and range of motion improvement in primary osteoarthritis of knee. J Res Med Sci. 2018;23:96.

    Google Scholar 

  54. Shams A, El-Sayed M, Gamal O, Ewes W. Subacromial injection of autologous platelet-rich plasma versus corticosteroid for the treatment of symptomatic partial rotator cuff tears. Eur J Orthop Surg Traumatol. 2016;26(8):837–42.

    Article  PubMed  Google Scholar 

  55. Montañez-Heredia E, Irízar S, Huertas PJ, Otero E, del Valle M, Prat I, et al. Intra-articular injections of platelet-rich plasma versus hyaluronic acid in the treatment of osteoarthritic knee pain: a randomized clinical trial in the context of the spanish national health care system. Int J Mol Sci. 2016;17:1064.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Di Martino A, Di Matteo B, Papio T, et al. Platelet-rich plasma versus hyaluronic acid injections for the treatment of knee osteoarthritis: results at 5 years of a double-blind, randomized controlled trial. Am J Sports Med. 2019;47(2):347–54. https://doi.org/10.1177/0363546518814532.

    Article  PubMed  Google Scholar 

  57. Albanese A, Licata ME, Polizzi B, Campisi G. Platelet-rich plasma (PRP) in dental and oral surgery: from the wound healing to bone regeneration. Immun Ageing. 2013;10(1):1.

    Article  Google Scholar 

  58. Centeno CJ, Pastoriza SM. Past, current and future interventional orhtobiologics techniques and how they relate to regenerative rehabilitation: A clinical commentary. Int J Sports Phys Ther. 2020;15:301–25.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Cotter EJ, Wang KC, Yanke AB, Chubinskaya S. Bone marrow aspirate concentrate for cartilage defects of the knee: from bench to beside evidence. Cartilage. 2018;9(2):161–70.

    Article  CAS  PubMed  Google Scholar 

  60. Pittenger MF, Mackay AM, Beck SC, et al. Multilineage potential of adult human mesenchymal stem cells. Science. 1999;284(5411):143–7.

    Article  CAS  PubMed  Google Scholar 

  61. Dominici M, Le Blanc K, Mueller I, et al. Minimal criteria for defining multipotent mesenchymal stromal cells. The International society for cellular therapy position statement. Cytotherapy. 2006;8(4):315–7.

    Article  CAS  PubMed  Google Scholar 

  62. Richardson SM, Kalamegam G, Pushparaj PN, et al. Mesenchymal stem cells in regenerative medicine: Focus on articular cartilage and intervertebral disc regeneration. Methods. 2016;99:69–80.

    Article  CAS  PubMed  Google Scholar 

  63. Mohamed-Ahmed S, Fristad I, Lie SA, et al. Adipose derived and bone marrow mesenchymal stem cells: a donor-matched comparison. Stem Cell Res Ther. 2018;9(1):168. https://doi.org/10.1186/s13287-018-0914-1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Li CY, Wu XY, Tong JB, et al. Comparative analysis of human mesenchymal stem cells from bone marrow and adipose tissue under xeno-free conditions for cell therapy. Stem Cell Res Ther. 2015;6:55.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Chung MJ, Son JY, Park SY, et al. Mesechymal stem cell and microRNA therapy of musculoskeletal diseases. Int J Stem Cells. 2021;14(2):150–67.

    Article  PubMed  Google Scholar 

  66. Yan D, Chen L, Li Z, Guo W, Sun W. Autologous mesenchymal stem cell implantation in the management of osteonecrosis of the femoral head. Curr Orthop Pract. 2015;26(3):265–8.

    Article  Google Scholar 

  67. Mao Q, Wang W, Xu T, et al. Combination treatment of biomechanical support and targeted intra-arterial infusion of peripheral blood stem cells mobilized by granulocyte-colony stimulating factor for the osteonecrosis of the femoral head: a randomized controlled clinical trial. J Bone Miner Res. 2015;30(4):647–56.

    Article  PubMed  Google Scholar 

  68. Mazzotta A, Stagni C, Rocchi M, et al. Bone marrow aspirate concentrate / plataelet-rich fibrin augmentation accelerates healing of aseptic upper limb non-unions. J Orthop Traumatol. 2021;22:21. https://doi.org/10.1186/.s10195-021-00582-y.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Pascual-Garrido C, Rolon A, Makino A. Treatment of chronic patellar tendinopathy with autologous bone marrow stem cells: a 5-year follow up. Stem Cells Int. 2012;2012: 953510.

    Article  PubMed  Google Scholar 

  70. Investigation of mesenchymal stem cell therapy for the treatment of osteoarthritis of the knee - Study Results - ClinicalTrials.gov.

  71. Treatment of tendon injury using mesenchymal stem cells - Study Results - ClinicalTrials.gov.

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Authors and Affiliations

  1. Department of Musculoskeletal and Interventional Radiology, King Fahad Medical City, 11525, Riyadh, Saudi Arabia

    Ahmad M. Aljefri & Salem Bauones

  2. Department of Radiology, Vancouver General Hospital/University of British Columbia, Vancouver, BC, Canada

    Cormac O. Brien, Adnan M. Sheikh & Hugue Ouellette

  3. Department of Radiology, Changi General Hospital, Singapore, Singapore

    Tien Jin Tan

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  1. Ahmad M. Aljefri
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Aljefri, A.M., Brien, C.O., Tan, T.J. et al. Clinical Applications of PRP: Musculoskeletal Applications, Current Practices and Update. Cardiovasc Intervent Radiol 46, 1504–1516 (2023). https://doi.org/10.1007/s00270-023-03567-y

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