Platelet-rich plasma [PRP] has received increasing interest across many musculoskeletal disciplines and has been widely applied clinically to stimulate tissue healing in numerous anatomical regions. The known actions of platelet-derived factors suggest that PRP may have significant potential in the treatment of pathological conditions of cartilage, tendon, ligament, and muscle.
The aim of this manuscript is to review current literature regarding the biology of PRP and the efficacy of using PRP to augment healing of tendon ligament and muscle injuries, as well as early osteoarthritis.
A comprehensive literature review of musculoskeletal applications of PRP was performed, including basic science and clinical studies such as randomized controlled trials, case controlled series, and case series.
The most compelling evidence to support the efficacy of PRP is for its application to tendon damage associated with lateral and medial epicondylitis. Although some promising studies have been reported supporting the use of PRP in osteoarthritis and ligament and muscle injuries, it currently remains unknown whether PRP effectively alters the progression of osteoarthritis or aids the healing of ligament and muscle tissues.
The rationale for the use of PRP to improve tissue healing is strong, but the efficacy for many musculoskeletal applications remains unproven. PRP has been shown to be a safe treatment. A number of questions regarding PRP remain unanswered, including the optimal concentration of platelets, what cell types should be present, the ideal frequency of application, or the optimal rehabilitation regimen for tissue repair and return to full function.
This is a preview of subscription content, log in to check access.
Buy single article
Instant access to the full article PDF.
Price includes VAT for USA
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
This is the net price. Taxes to be calculated in checkout.
Anitua E, Andia I, Ardanza B, Nurden P and Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemos. 2004; 91: 4–15.
Anitua E, Sanchez M, Nurden AT, Zalduendo MM, De la Fuente M, Azofra J and Andia, I. Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology. 2007; 46: 1769–1772.
Arnoczky SP, Caballero O and Yeni YN. Platelet-rich Plasma To Augment Connective Tissue Healing: Making Sense of It All. J Am Acad Orthop Surg. 2010; 18: 445–446.
Barrett S and Erredge S. Growth Factors For Chronic Plantar Fasciitis? Podiatry Today. 2004; 17: 36–42.
Bogatch MT, Ferachi DG, Kyle B, Popinchalk S, Howell MH, Ge DX, You ZB and Savoie FH. Is Chemical Incompatibility Responsible for Chondrocyte Death Induced by Local Anesthetics? Am J Sports Med. 2010; 38: 520–526.
Carmona J, Arguelles D, Climent F, Prades M, Soler R, Vidal F and Orozco L. Autologous platelet-rich plasma injected intraarticularly diminished synovial effusion and degree of lameness in horses affected with severe joint disease. Annual Scientific Meeting of the European College of Veterinary Surgeons. Lyon. 2005.
Castillo TN, Pouliot MA, Kim HJ and Dragoo JL. Comparison of Growth Factor and Platelet Concentration From Commercial Platelet-Rich Plasma Separation Systems. Am J Sports Med. 2010; 39: 266–271.
Castricini R, Longo UG, De Benedetto M, Panfoli N, Pirani P, Zini R, Maffulli N and Denaro V. Platelet-Rich Plasma Augmentation for Arthroscopic Rotator Cuff Repair. Am J Sports Med. 2011; 39: 258–265.
Creaney L and Hamilton B. Growth factor delivery methods in the management of sports injuries: the state of play. Br J Sports Med. 2008; 42: 314–20.
de Mos M, van der Windt AE, Jahr H, van Schie HTM, Weinans H, Verhaar JAN and van Osch G. Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med. 2008; 36: 1171–1178.
de Vos RJ, Weir A, Tol JL, Verhaar JAN, Weinans H and van Schie HTM. No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy. Br J Sports Med. 2011; 45: 387–392.
De Vos RJ, Weir A, Van Schie HTM, Bierma-Zeinstra SMA, Verhaar JAN, Weinans H and Tol JL. Platelet-rich plasma injection for chronic Achilles tendinopathy: A randomized controlled trial. J Am Med Assoc. 2010; 303: 144–149.
Drengk A, Zapf A, Sturmer EK, Sturmer KM and Frosch KH. Influence of Platelet-Rich Plasma on Chondrogenic Differentiation and Proliferation of Chondrocytes and Mesenchymal Stem Cells. Cells Tissues Organs. 2009; 189: 317–326.
Engebretsen L et al. IOC consensus paper on the use of platelet-rich plasma in sports medicine. Br J Sports Med. 2010; 44: 1072–1081.
Engert JC, Berglund EB and Rosenthal N. Proliferation precedes differentiation in IGF-I-stimulated myogenesis. J Cell Biol. 1996; 135: 431–440.
Ferrari M, Zia S, Valbonesi M, Henriquet F, Venere G, Spagnolo S, Grasso MA and Panzani I. A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac-surgery. Int J Artificial Organs. 1987; 10: 47–50.
Filardo G, Kon E, Della Villa S, Vincentelli F, Fornasari PM and Marcacci M. Use of platelet-rich plasma for the treatment of refractory jumper’s knee. Int Orthop. 2010; 34: 909–15.
Fortier LA, Mohammed HO, Lust G and Nixon AJ. Insulin-like growth factor-I enhances cell-based repair of articular cartilage. J Bone Joint Surg Am. 2002; 84: 276–288.
Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB and Rodeo SA. Platelet-rich plasma: From basic science to clinical applications. Am J Sports Med. 2009; 37: 2259–2272.
Frenkel SR, Saadeh PB, Mehrara BJ, Chin GS, Steinbrech DS, Brent B, Gittes GK and Longker MT. Transforming growth factor beta superfamily members: Role in cartilage modeling. Plastic Recon Surg. 2000; 105: 980–990.
Gandhi A, Dumas C, O’Connor JP, Parsons JR and Lin SS. The effects of local platelet rich plasma delivery on diabetic fracture healing. Bone. 2006; 38: 540–546.
Gaweda K, Tarczynska M and Krzyzanowski W. Treatment of Achilles Tendinopathy with Platelet-Rich Plasma. Int J Sports Med. 2010; 31: 577–583.
Gosens T, Peerbooms JC, van Laar W and den Oudsten BL. Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis. Am J Sports Med. 2011; 39: 1200–1208.
Grishko V, Xu M, Wilson G and Pearsall AW. Apoptosis and Mitochondrial Dysfunction in Human Chondrocytes Following Exposure to Lidocaine, Bupivacaine, and Ropivacaine. J Bone Joint Surg Am. 2010; 92: 609–618.
Grotendorst GR, Martin GR, Pencev D, Sodek J and Harvey AK. Stimulation of granulation-tissue formation by platelet-derived growth-factor in normal and diabetic rats. J Clin Invest. 1985; 76: 2323–2329.
Hamilton BH and Best TM. Platelet-Enriched Plasma and Muscle Strain Injuries: Challenges Imposed by the Burden of Proof. Clin J Sports Med. 2011; 21: 31–36.
Hammond JW, Hinton RY, Curl LA, Muriel JM and Lovering RM. Use of autologous platelet-rich plasma to treat muscle strain injuries. Am J Sports Med. 2009; 37: 1135–1142.
Harmon KG. Muscle injuries and PRP: what does the science say? Brit J Sports Med. 2010; 44: 616–617.
Harrison S, Vavken P, Kevy S, Jacobson M, Zurakowski D and Murray MM. Platelet activation by collagen provides sustained release of anabolic cytokines. Am J Sports Med. 2011; 39: 729–734.
Hildebrand KA, Woo SLY, Smith DW, Allen CR, Deie M. Taylor BJ and Schmidt CC. The effects of platelet-derived growth factor-BB on healing of the rabbit medial collateral ligament-An in vivo study. Am J Sports Med. 1998; 26: 549–554.
Joyce ME, Jingushi S, Scully SP and Bolander ME. Role of growth factors in fracture healing. Progress Clin Biol Res. 1991; 365: 391–416.
Kajikawa Y, Morihara T, Sakamoto H, Matsuda K, Oshima Y, Yoshida A, Nagae M, Arai Y, Kawata M and Kubo T. Platelet-rich plasma enhances the initial mobilization of circulation-derived cells for tendon healing. J Cell Physiol. 2008; 215: 837–845.
Koerner J, Abdelmessieh P, Azad V, Szczepanowski K, Lin SS and Pinzur M. Platelet-Rich Plasma and Its Uses in Foot and Ankle Surgery. Techn Foot Ankle Surg. 2008; 7: 72–78.
Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S and Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010; 18: 472–9.
Kon E, Filardo G, Delcogliano M, Presti ML, Russo A, Bondi A, Di Martino A, Cenacchi A, Fornasari PM and Marcacci M. Platelet-rich plasma: New clinical application A pilot study for treatment of jumper’s knee. Injury. 2009; 40: 598–603.
Li N L, Hu H, Lindqvist M, Wikstrom-Jonsson E, Goodall AH and Hjemdahl P. Platelet-leukocyte cross talk in whole blood. Arterioscler Thromb Vasc Biol. 2000; 20: 2702–2708.
Li Y and Huard J. Differentiation of muscle-derived cells into myofibroblasts in injured skeletal muscle. Am J Path. 2002; 161: 895–907.
Majewski M, Ochsner PE, Liu FJ, Fluckiger R and Evans CH. Accelerated Healing of the Rat Achilles Tendon in Response to Autologous Conditioned Serum. Am J Sports Med. 2009; 37: 2117–2125.
Marx RE. Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dentistry. 2001; 10: 225–228.
McCarrel T and 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. 2009; 27: 1033–1042.
Mishra A and Pavelko T. Treatment of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma. Am J Sports Med. 2006; 34: 1774–1778.
Nin JRV, Gasque GM, Azcarate AV, Beola JDA and Gonzalez MH. Has Platelet-Rich Plasma Any Role in Anterior Cruciate Ligament Allograft Healing? Arthroscopy. 2009; 25: 1206–1213.
Obaid H and Connell D. Cell Therapy in Tendon Disorders What Is the Current Evidence? Am J Sports Med. 2010; 38: 2123–2132.
Peerbooms JC, Sluimer J, Bruijn DJ and 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: 255–262.
Pietrzak WS and Eppley BL. Platelet rich plasma: Biology and new technology. J Craniofacial Surg. 2005; 16: 1043–1054.
Randelli PS, Arrigoni P, Cabitza P, Volpi P and Maffulli N. Autologous platelet rich plasma for arthroscopic rotator cuff repair. A pilot study. Disability Rehab. 2008; 30: 1584–1589.
Randelli P, Arrigoni P, Ragone V, Aliprandi A and Cabitza P. Platelet Rich Plasma In Arthroscopic Rotator Cuff Repair: A Prospective Rct Study, 2-Year Follow-Up. Journal of Shoulder and Elbow Surgery. 2010; 20: 518–528.
Ranly DM, McMillan J, Keller T, Lohmann CH, Meunch T, Cochran DL Schwartz Z and Boyan BD. Platelet-derived growth factor inhibits demineralized bone matrix-induced intramuscular cartilage and bone formation-A study of immunocompromised mice. J Bone Joint Surg Am. 2005; 87: 2052–2064.
Rodeo SA, Delos D, Williams RJ, Adler RA, Pearle A and Warren RF. The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: A prospective randomized clinical study. Under Review, Am J Sports Med, 2011.
Sampson S, Reed M, Silvers H, Meng M and Mandelbaum B. Injection of Platelet-Rich Plasma in Patients with Primary and Secondary Knee Osteoarthritis A Pilot Study. Am J Phys Med Rehab. 2010; 89: 961–969.
Sanchez M, Anitua E, Azofra J, Andia I, Padilla S and Mujika I. Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med. 2007; 35: 245–51.
Sanchez M, Anitua E, Azofra J, Prado R, Muruzabal F and Andia I. Ligamentization of Tendon Grafts Treated With an Endogenous Preparation Rich in Growth Factors: Gross Morphology and Histology. Arthroscopy. 2010; 26: 470–480.
Sanchez M, Anitua E, Orive G, Mujika I and Andia I. Platelet-Rich Therapies in the Treatment of Orthopaedic Sport Injuries. Sports Med. 2009; 39: 345–354.
Schepull T, Kvist, J, Norrman H, Trinks M, Berlin G and 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: 38–47.
Schnabel LV, Mohammed HO, Miller BJ, McDermott WG, Jacobson MS, Santangelo KS and Fortier LA. Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons. J Orthop Res. 2007; 25: 230–240.
Sharma P and Maffulli N. Current concepts review tendon injury and tendinopathy: Healing and repair. J Bone Joint Surg Am. 2005; 87: 187–202.
Shen W, Li Y, Tang Y, Cummins J and Huard J. NS-398, a cyclooxygenase-2-specific inhibitor, delays skeletal muscle healing by decreasing regeneration and promoting fibrosis. Am J Path. 2005; 167: 1105–1117.
Szczodry M, Coyle CH, Kramer SJ, Smolinski P and Chu CR. Progressive Chondrocyte Death After Impact Injury Indicates a Need for Chondroprotective Therapy. Am J Sports Med. 2009; 37: 2318–2322.
Varga-Szabo D, Pleines I and Nieswandt B. Cell adhesion mechanisms in platelets. Arterioscler Thromb Vasc Biol. 2008; 28: 403–412.
Vogrin M, Rupreht M, Dinevski D, Haspl M, Kuhta M, Jevsek M, Knezevic M and Rozman P. Effects of a Platelet Gel on Early Graft Revascularization after Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Double-Blind, Clinical Trial. Europ Surg Res. 2010; 45: 77–85.
Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cusco X and Garcia-Balletbo M. Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life. Archiv Orthop Traum Surg. 2010; 131: 311–7.
Wright-Carpenter T, Klein P, Schaferhoff P, Appell HJ, Mir LM, and Wehling P. Treatment of muscle injuries by local administration of autologous conditioned serum: A pilot study on sportsmen with muscle strains. Int J Sports Med. 2004; 25: 588–593.
Wright-Carpenter T, Opolon P, Appell HJ, Meijer H, Wehling P and Mir LM. Treatment of muscle injuries by local administration of autologous conditioned serum: Animal experiments using a muscle contusion model. Int J Sports Med. 2004; 25: 582–587.
Wurgler-Hauri CC, Dourte LM, Baradet TC, Williams GR and Soslowsky LJ. Temporal expression of 8 growth factors in tendon-to-bone healing in a rat supraspinatus model. J Shoulder Elb Surgery. 2007; 16: 198S–203S.
Zhang JY and Wang JHC. Platelet-Rich Plasma Releasate Promotes Differentiation of Tendon Stem Cells Into Active Tenocytes. Am J Sports Med. 2010; 38: 2477–2486.
Zummstein MA Lesbats V, Trojani C and Boileau P. A New Technique of Biologic Augmentation in Repair of Chroni Rotator Cuff Tears using Autologous Platelet Rich Fibrin (PRF): Vascularization Response and Tendon Healing in a Prospective Randomized Trial. ASES Meeting 2010 Abstracts, p. 27.
The authors wish to thank Catherine Hayter, MBBS for the assistance with the analysis of the MRI images included in this manuscript.
Each author certifies that he or she has no commercial associations (e.g., consultancies, stock ownership, equity interest, patent/licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article.
This work was performed at Hospital for Special Surgery.
About this article
Cite this article
Halpern, B.C., Chaudhury, S. & Rodeo, S.A. The Role of Platelet-Rich Plasma in Inducing Musculoskeletal Tissue Healing. HSS Jrnl 8, 137–145 (2012). https://doi.org/10.1007/s11420-011-9239-7
- platelet-rich plasma