Current Clinical Recommendations for Use of Platelet-Rich Plasma

Abstract

Purpose of Review

This review evaluates current clinical literature on the use of platelet-rich plasma (PRP), including leukocyte-rich PRP (LR-PRP) and leukocyte-poor PRP (LP-PRP), in order to develop evidence-based recommendations for various musculoskeletal indications.

Recent Findings

Abundant high-quality evidence supports the use of LR-PRP injection for lateral epicondylitis and LP-PRP for osteoarthritis of the knee. Moderate high-quality evidence supports the use of LR-PRP injection for patellar tendinopathy and of PRP injection for plantar fasciitis and donor site pain in patellar tendon graft BTB ACL reconstruction. There is insufficient evidence to routinely recommend PRP for rotator cuff tendinopathy, osteoarthritis of the hip, or high ankle sprains. Current evidence demonstrates a lack of efficacy of PRP for Achilles tendinopathy, muscle injuries, acute fracture or nonunion, surgical augmentation in rotator cuff repair, Achilles tendon repair, and ACL reconstruction.

Summary

PRP is a promising treatment for some musculoskeletal diseases; however, evidence of its efficacy has been highly variable depending on the specific indication. Additional high-quality clinical trials with longer follow-up will be critical in shaping our perspective of this treatment option.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.

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

    Google Scholar 

  2. 2.

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

    PubMed  PubMed Central  Google Scholar 

  3. 3.

    Le A, Dragoo JL. Orthobiologics: clinical application of platelet-rich plasma and stem cell therapy. DeLee Drezs Orthop Sports Med. 5th Edition. Elsevier; XXXX p XXX.

  4. 4.

    • Le AD, Enweze L, DeBaun MR, Dragoo JL. Platelet-rich plasma. Clin Sports Med. 2018;XX:XX–XX. Recent (in-press) comprehensive review of PRP literature outlining best available clinical evidence as well as pre-clinical evidence, where appropriate, for a variety of sports medicine applications.

  5. 5.

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

    CAS  PubMed  Google Scholar 

  6. 6.

    Degen RM, Bernard JA, Oliver KS, Dines JS. Commercial separation systems designed for preparation of platelet-rich plasma yield differences in cellular composition. HSS J. 2017;13:75–80.

    PubMed  Google Scholar 

  7. 7.

    Magalon J, Bausset O, Serratrice N, Giraudo L, Aboudou H, Veran J, et al. Characterization and comparison of 5 platelet-rich plasma preparations in a single-donor model. Arthroscopy. 2014;30:629–38.

    PubMed  Google Scholar 

  8. 8.

    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;39:266–71.

    PubMed  Google Scholar 

  9. 9.

    Dragoo JL, Braun HJ, Durham JL, Ridley BA, Odegaard JI, Luong R, et al. Comparison of the acute inflammatory response of two commercial platelet-rich plasma systems in healthy rabbit tendons. Am J Sports Med. 2012;40:1274–81.

    PubMed  Google Scholar 

  10. 10.

    Mazzocca AD, McCarthy MBR, Chowaniec DM, Cote MP, Romeo AA, Bradley JP, et al. Platelet-rich plasma differs according to preparation method and human variability. J Bone Joint Surg Am. 2012;94:308–16.

    PubMed  PubMed Central  Google Scholar 

  11. 11.

    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;39:2135–40.

    Google Scholar 

  12. 12.

    • Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Effect of high-volume injection, platelet-rich plasma, and sham treatment in chronic midportion achilles tendinopathy: a randomized double-blinded prospective study. Am J Sports Med. 2017;45:2034–43. RCT demonstrating efficacy of single high-volume injection (50 mL) of 0.5% bupivacaine (10 mL), methylprednisolone (20 mg), and normal saline (40 mL) as well as four sequential injections of PRP for Achilles tendinopathy.

    Google Scholar 

  13. 13.

    Krogh TP, Ellingsen T, Christensen R, Jensen P, Fredberg U. Ultrasound-guided injection therapy of Achilles tendinopathy with platelet-rich plasma or saline: a randomized, blinded, placebo-controlled trial. Am J Sports Med. 2016;44:1990–7.

    PubMed  PubMed Central  Google Scholar 

  14. 14.

    Behera P, Dhillon M, Aggarwal S, Marwaha N, Prakash M. Leukocyte-poor platelet-rich plasma versus bupivacaine for recalcitrant lateral epicondylar tendinopathy. J Orthop Surg. 2015;23:6–10.

    Google Scholar 

  15. 15.

    Gautam V, Verma S, Batra S, Bhatnagar N, Arora S. Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg. 2015;23:1–5.

    CAS  Google Scholar 

  16. 16.

    Lebiedziński R, Synder M, Buchcic P, Polguj M, Grzegorzewski A, Sibiński M. A randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis. Int Orthop. 2015;39:2199–203.

    PubMed  Google Scholar 

  17. 17.

    • Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med. 2014;42:463–71. Large multicenter double-blind randomized controlled trial for PRP and lateral epicondylitis, demonstrating significant symptomatic and functional benefit of PRP injection.

    PubMed  PubMed Central  Google Scholar 

  18. 18.

    Montalvan B, Le Goux P, Klouche S, Borgel D, Hardy P, Breban M. 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. 2016;55:279–85.

    PubMed  Google Scholar 

  19. 19.

    Palacio EP, Schiavetti RR, Kanematsu M, Ikeda TM, Mizobuchi RR, Galbiatti JA. Effects of platelet-rich plasma on lateral epicondylitis of the elbow: prospective randomized controlled trial. Rev Bras Ortop Engl Ed. 2016;51:90–5.

    Google Scholar 

  20. 20.

    Yadav R. Comparison of local injection of platelet rich plasma and corticosteroids in the treatment of lateral epicondylitis of humerus. J Clin Diagn Res [Internet]. 2015 [cited 2018 Apr 2]; Available from: http://jcdr.net/article_fulltext.asp?issn=0973-709x&year=2015&volume=9&issue=7&page=RC05&issn=0973-709x&id=6213.

  21. 21.

    Dragoo JL, Wasterlain AS, Braun HJ, Nead KT. Platelet-rich plasma as a treatment for patellar tendinopathy: a double-blind, randomized controlled trial. Am J Sports Med. 2014;42:610–8.

    Google Scholar 

  22. 22.

    Vetrano M, Castorina A, Vulpiani MC, Baldini R, Pavan A, Ferretti A. Platelet-rich plasma versus focused shock waves in the treatment of Jumper’s knee in athletes. Am J Sports Med. 2013;41:795–803.

    PubMed  Google Scholar 

  23. 23.

    Acosta-Olivo C, Elizondo-Rodriguez J, Lopez-Cavazos R, Vilchez-Cavazos F, Simental-Mendia M, Mendoza-Lemus O. Plantar fasciitis—a comparison of treatment with intralesional steroids versus platelet-rich plasma: a randomized, blinded study. J Am Podiatr Med Assoc. 2017;107:490–6.

    PubMed  PubMed Central  Google Scholar 

  24. 24.

    Jain K, Murphy PN, Clough TM. Platelet rich plasma versus corticosteroid injection for plantar fasciitis: a comparative study. Foot. 2015;25:235–7.

    Google Scholar 

  25. 25.

    Jain SK, Suprashant K, Kumar S, Yadav A, Kearns SR. Comparison of plantar fasciitis injected with platelet-rich plasma vs corticosteroids. Foot Ankle Int. 2018. https://doi.org/10.1177/1071100718762406.

    Google Scholar 

  26. 26.

    Mahindra P, Yamin M, Selhi HS, Singla S, Soni A. Chronic plantar fasciitis: effect of platelet-rich plasma, corticosteroid, and placebo. Orthopedics. 2016;39:e285–9.

    PubMed  Google Scholar 

  27. 27.

    Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014;35:313–8.

    PubMed  Google Scholar 

  28. 28.

    Say F, Gürler D, İnkaya E, Bülbül M. Comparison of platelet-rich plasma and steroid injection in the treatment of plantar fasciitis. Acta Orthop Traumatol Turc. 2014;48:667–72.

    PubMed  Google Scholar 

  29. 29.

    Sherpy NA, Hammad MA, Hagrass HA, Samir H, Abu-ElMaaty SE, Mortada MA. Local injection of autologous platelet rich plasma compared to corticosteroid treatment of chronic plantar fasciitis patients: a clinical and ultrasonographic follow-up study. Egypt Rheumatol. 2016;38:247–52.

    Google Scholar 

  30. 30.

    Shetty VD, Dhillon M, Hegde C, Jagtap P, Shetty S. A study to compare the efficacy of corticosteroid therapy with platelet-rich plasma therapy in recalcitrant plantar fasciitis: a preliminary report. Foot Ankle Surg. 2014;20:10–3.

    PubMed  Google Scholar 

  31. 31.

    Tiwari M, Bhargava R. Platelet rich plasma therapy: a comparative effective therapy with promising results in plantar fasciitis. J Clin Orthop Trauma. 2013;4:31–5.

    PubMed  PubMed Central  Google Scholar 

  32. 32.

    Vahdatpour B, Kianimehr L, Moradi A, Haghighat S. Beneficial effects of platelet-rich plasma on improvement of pain severity and physical disability in patients with plantar fasciitis: a randomized trial. Adv Biomed Res. 2016;5:179.

    PubMed  PubMed Central  Google Scholar 

  33. 33.

    Kesikburun S, Tan AK, Yılmaz B, Yaşar E, Yazıcıoğlu K. Platelet-rich plasma injections in the treatment of chronic rotator cuff tendinopathy: a randomized controlled trial with 1-year follow-up. Am J Sports Med. 2013;41:2609–16.

    PubMed  PubMed Central  Google Scholar 

  34. 34.

    Rha D, Park G-Y, Kim Y-K, Kim MT, Lee SC. Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil. 2013;27:113–22.

    Google Scholar 

  35. 35.

    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;26:837–42.

    Google Scholar 

  36. 36.

    • Miller LE, Parrish WR, Roides B, Bhattacharyya S. Efficacy of platelet-rich plasma injections for symptomatic tendinopathy: systematic review and meta-analysis of randomised injection-controlled trials. BMJ Open Sport Exerc Med. 2017;3:e000237. Recent review of PRP injections on tendinopathies demonstrating an overall trend supporting the use of PRP for symptomatic tendinopathies. However, there were differences depending on the specific site of tendinopathy.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    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;39:1200–8.

    PubMed  Google Scholar 

  38. 38.

    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;38:255–62.

    PubMed  Google Scholar 

  39. 39.

    Arirachakaran A, Sukthuayat A, Sisayanarane T, Laoratanavoraphong S, Kanchanatawan W, Kongtharvonskul J. Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis. J Orthop Traumatol. 2016;17:101–12.

    PubMed  Google Scholar 

  40. 40.

    Krogh TP, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U, et al. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. 2013;41:1435–46.

    PubMed  Google Scholar 

  41. 41.

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

    PubMed  Google Scholar 

  42. 42.

    de Jonge S, de Vos RJ, Weir A, van Schie HTM, Bierma-Zeinstra SMA, Verhaar JAN, et al. One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: a double-blind randomized placebo-controlled trial. Am J Sports Med. 2011;39:1623–9.

    PubMed  PubMed Central  Google Scholar 

  43. 43.

    Neufeld SK, Cerrato R. Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg. 2008;16:338–46.

    Google Scholar 

  44. 44.

    Yang W-Y, Han Y-H, Cao X-W, Pan J-K, Zeng L-F, Lin J-T, et al. Platelet-rich plasma as a treatment for plantar fasciitis: a meta-analysis of randomized controlled trials. Medicine (Baltimore). 2017;96:e8475.

    Google Scholar 

  45. 45.

    • Singh P, Madanipour S, Bhamra JS, Gill I. A systematic review and meta-analysis of platelet-rich plasma versus corticosteroid injections for plantar fasciopathy. Int Orthop. 2017;41:1169–81. Recent systematic review and meta-analysis demonstrating PRP as a superior treatment modality to corticosteroid injections for plantar fasciopathy.

    PubMed  Google Scholar 

  46. 46.

    Barber FA. Triple-loaded single-row versus suture-bridge double-row rotator cuff tendon repair with platelet-rich plasma fibrin membrane: a randomized controlled trial. Arthroscopy. 2016;32:753–61.

    PubMed  Google Scholar 

  47. 47.

    Jo CH, Shin JS, Shin WH, Lee SY, Yoon KS, Shin S. Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial. Am J Sports Med. 2015;43:2102–10.

    PubMed  PubMed Central  Google Scholar 

  48. 48.

    Pandey V, Bandi A, Madi S, Agarwal L, Acharya KKV, Maddukuri S, et al. 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 Elb Surg. 2016;25:1312–22.

    Google Scholar 

  49. 49.

    Saltzman BM, Jain A, Campbell KA, Mascarenhas R, Romeo AA, Verma NN, et al. Does the use of platelet-rich plasma at the time of surgery improve clinical outcomes in arthroscopic rotator cuff repair when compared with control cohorts? A systematic review of meta-analyses. Arthroscopy. 2016;32:906–18.

    PubMed  Google Scholar 

  50. 50.

    Holtby R, Christakis M, Maman E, MacDermid JC, Dwyer T, Athwal GS, et al. Impact of platelet-rich plasma on arthroscopic repair of small- to medium-sized rotator cuff tears: a randomized controlled trial. Orthop J Sports Med. 2016;4:232596711666559.

    Google Scholar 

  51. 51.

    Ebert JR, Wang A, Smith A, Nairn R, Breidahl W, Zheng MH, et al. A midterm evaluation of postoperative platelet-rich plasma injections on arthroscopic supraspinatus repair: a randomized controlled trial. Am J Sports Med. 2017;45:2965–74.

    PubMed  PubMed Central  Google Scholar 

  52. 52.

    Malavolta EA, Gracitelli MEC, Ferreira Neto AA, Assunção JH, Bordalo-Rodrigues M, de Camargo OP. Platelet-rich plasma in rotator cuff repair: a prospective randomized study. Am J Sports Med. 2014;42:2446–54.

    PubMed  Google Scholar 

  53. 53.

    D’Ambrosi R, Palumbo F, Paronzini A, Ragone V, Facchini RM. Platelet-rich plasma supplementation in arthroscopic repair of full-thickness rotator cuff tears: a randomized clinical trial. Musculoskelet Surg. 2016;100:25–32.

    PubMed  Google Scholar 

  54. 54.

    Flury M, Rickenbacher D, Schwyzer H-K, Jung C, Schneider MM, Stahnke K, et al. Does pure platelet-rich plasma affect postoperative clinical outcomes after arthroscopic rotator cuff repair?: a randomized controlled trial. Am J Sports Med. 2016;44:2136–46.

    PubMed  Google Scholar 

  55. 55.

    Cai Y, Zhang C, Lin X. Efficacy of platelet-rich plasma in arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis. J Shoulder Elb Surg. 2015;24:1852–9.

    Google Scholar 

  56. 56.

    Filardo G, Di Matteo B, Kon E, Merli G, Marcacci M. Platelet-rich plasma in tendon-related disorders: results and indications. Knee Surg Sports Traumatol Arthrosc [Internet]. 2016 [cited 2018 Mar 14]; Available from: http://link.springer.com/10.1007/s00167-016-4261-4

  57. 57.

    • Smith KM, Le A, Costouros J, Dragoo JL. Biologics for rotator cuff repair: a critical analysis review. JBJS Rev. 2018;XX:XX–XX. Recent review on use of biologic augmentation for rotator cuff repair. Review concluded that PRP did not demonstrate efficacy as an adjuvant in rotator cuff repair. Subgroup analyses did reveal decreased re-tear rate with PRP augmentation in small and medium tears treated with arthroscopic double-row repair.

  58. 58.

    Vavken P, Sadoghi P, Palmer M, Rosso C, Mueller AM, Szoelloesy G, et al. Platelet-rich plasma reduces retear rates after arthroscopic repair of small- and medium-sized rotator cuff tears but is not cost-effective. Am J Sports Med. 2015;43:3071–6.

    PubMed  PubMed Central  Google Scholar 

  59. 59.

    Allahverdi A, Sharifi D, Takhtfooladi MA, Hesaraki S, Khansari M, Dorbeh SS. Evaluation of low-level laser therapy, platelet-rich plasma, and their combination on the healing of Achilles tendon in rabbits. Lasers Med Sci. 2015;30:1305–13.

    PubMed  Google Scholar 

  60. 60.

    Yuksel S, Gulec MA, Gultekin MZ, Adanir O, Caglar A, Beytemur O, et al. Comparison of the early period effects of bone marrow-derived mesenchymal stem cells and platelet-rich plasma on the Achilles tendon ruptures in rats. Connect Tissue Res. 2016;57:360–73.

    CAS  PubMed  Google Scholar 

  61. 61.

    Aspenberg P. Platelet concentrates and Achilles tendon healing. J Orthop Res. 2013;31:1500.

    PubMed  Google Scholar 

  62. 62.

    De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Vadala A, Argento G, et al. Can platelet-rich plasma have a role in Achilles tendon surgical repair? Knee Surg Sports Traumatol Arthrosc. 2016;24:2231–7.

    Google Scholar 

  63. 63.

    Zou J, Mo X, Shi Z, Li T, Xue J, Mei G, et al. A prospective study of platelet-rich plasma as biological augmentation for acute Achilles tendon rupture repair. Biomed Res Int. 2016;2016:1–8.

    Google Scholar 

  64. 64.

    Di Matteo B, Loibl M, Andriolo L, Filardo G, Zellner J, Koch M, et al. Biologic agents for anterior cruciate ligament healing: a systematic review. World J Orthop. 2016;7:592–603.

    PubMed  PubMed Central  Google Scholar 

  65. 65.

    Sánchez M, Anitua E, Azofra J, Prado R, Muruzabal F, Andia I. Ligamentization of tendon grafts treated with an endogenous preparation rich in growth factors: gross morphology and histology. Arthroscopy. 2010;26:470–80.

    PubMed  Google Scholar 

  66. 66.

    Vogrin M, Rupreht M, Dinevski D, Hašpl M, Kuhta M, Jevsek M, et al. Effects of a platelet gel on early graft revascularization after anterior cruciate ligament reconstruction: a prospective, randomized, double-blind, clinical trial. Eur Surg Res. 2010;45:77–85.

    CAS  PubMed  Google Scholar 

  67. 67.

    Andriolo L, Di Matteo B, Kon E, Filardo G, Venieri G, Marcacci M. PRP augmentation for ACL reconstruction. Biomed Res Int. 2015;2015:1–15.

    Google Scholar 

  68. 68.

    Figueroa D, Melean P, Calvo R, Vaisman A, Zilleruelo N, Figueroa F, et al. Magnetic resonance imaging evaluation of the integration and maturation of semitendinosus-gracilis graft in anterior cruciate ligament reconstruction using autologous platelet concentrate. Arthroscopy. 2010;26:1318–25.

    PubMed  Google Scholar 

  69. 69.

    Mirzatolooei F, Alamdari MT, Khalkhali HR. The impact of platelet-rich plasma on the prevention of tunnel widening in anterior cruciate ligament reconstruction using quadrupled autologous hamstring tendon. Bone Joint J. 2013;95–B:65–9.

    PubMed  Google Scholar 

  70. 70.

    Seijas R, Cuscó X, Sallent A, Serra I, Ares O, Cugat R. Pain in donor site after BTB-ACL reconstruction with PRGF: a randomized trial. Arch Orthop Trauma Surg. 2016;136:829–35.

    PubMed  Google Scholar 

  71. 71.

    Pearle AD, Warren RF, Rodeo SA. Basic science of articular cartilage and osteoarthritis. Clin Sports Med. 2005;24:1–12.

    PubMed  Google Scholar 

  72. 72.

    Battaglia M, Guaraldi F, Vannini F, Rossi G, Timoncini A, Buda R, et al. Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis. Orthopedics. 2013;36:e1501–8.

    PubMed  Google Scholar 

  73. 73.

    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.

    PubMed  Google Scholar 

  74. 74.

    • Doria C, Mosele GR, Caggiari G, Puddu L, Ciurlia E. Treatment of early hip osteoarthritis: ultrasound-guided platelet rich plasma versus hyaluronic acid injections in a randomized clinical trial. Joints. 2017;5:152–5. Recent RCT comparing PRP to HA for early hip OA. For moderate signs of hip OA, PRP and HA both demonstrated significantly improved symptomatic outcome measures at 6- and 12-month follow-up; however, there was no significant difference between PRP and HA.

    PubMed  PubMed Central  Google Scholar 

  75. 75.

    Sante LD, Villani C, Santilli V, Valeo M, Bologna E, Imparato L, et al. Intra-articular hyaluronic acid vs platelet-rich plasma in the treatment of hip osteoarthritis. Med Ultrason. 2016;18:463–8.

    PubMed  Google Scholar 

  76. 76.

    Cole BJ, Karas V, Hussey K, Merkow DB, Pilz K, Fortier LA. Hyaluronic acid versus platelet-rich plasma: a prospective, double-blind randomized controlled trial comparing clinical outcomes and effects on intra-articular biology for the treatment of knee osteoarthritis. Am J Sports Med. 2017;45:339–46.

    PubMed  Google Scholar 

  77. 77.

    Duymus TM, Mutlu S, Dernek B, Komur B, Aydogmus S, Kesiktas FN. Choice of intra-articular injection in treatment of knee osteoarthritis: platelet-rich plasma, hyaluronic acid or ozone options. Knee Surg Sports Traumatol Arthrosc. 2017;25:485–92.

    PubMed  Google Scholar 

  78. 78.

    Görmeli G, Görmeli CA, Ataoglu B, Çolak C, Aslantürk O, Ertem K. Multiple PRP injections are more effective than single injections and hyaluronic acid in knees with early osteoarthritis: a randomized, double-blind, placebo-controlled trial. Knee Surg Sports Traumatol Arthrosc. 2017;25:958–65.

    PubMed  Google Scholar 

  79. 79.

    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.

    PubMed  PubMed Central  Google Scholar 

  80. 80.

    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 [Internet]. 2016 [cited 2018 Mar 12];17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4964440/.

  81. 81.

    Paterson KL, Nicholls M, Bennell KL, Bates D. Intra-articular injection of photo-activated platelet-rich plasma in patients with knee osteoarthritis: a double-blind, randomized controlled pilot study. BMC Musculoskelet Disord [Internet]. 2016 [cited 2018 Mar 12];17. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4748460/.

  82. 82.

    Simental-Mendía M, Vílchez-Cavazos JF, Peña-Martínez VM, Said-Fernández S, Lara-Arias J, Martínez-Rodríguez HG. Leukocyte-poor platelet-rich plasma is more effective than the conventional therapy with acetaminophen for the treatment of early knee osteoarthritis. Arch Orthop Trauma Surg. 2016;136:1723–32.

    PubMed  Google Scholar 

  83. 83.

    • Smith PA. Intra-articular autologous conditioned plasma injections provide safe and efficacious treatment for knee osteoarthritis: an FDA-sanctioned, randomized, double-blind, placebo-controlled clinical trial. Am J Sports Med. 2016;44:884–91. Double-blind RCT demonstrating safety and efficacy of PRP for knee OA compared to saline placebo.

    PubMed  Google Scholar 

  84. 84.

    Vaquerizo V, Plasencia MÁ, Arribas I, Seijas R, Padilla S, Orive G, et al. Comparison of intra-articular injections of plasma rich in growth factors (PRGF-Endoret) versus durolane hyaluronic acid in the treatment of patients with symptomatic osteoarthritis: a randomized controlled trial. Arthroscopy. 2013;29:1635–43.

    PubMed  Google Scholar 

  85. 85.

    • Shen L, Yuan T, Chen S, Xie X, Zhang C. 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 [Internet]. 2017 [cited 2017 Jul 8];12. Available from: http://josr-online.biomedcentral.com/articles/10.1186/s13018-017-0521-3. Recent systematic review and meta-analysis of RCTs evaluating PRP for knee OA. Intra-articular PRP injections appear to be superior in treating pain relief and function symptoms of OA at 3, 6, and 12 months follow-up, compared with other injections, including saline placebo, HA, ozone, and corticosteroids.

  86. 86.

    • Riboh JC, Saltzman BM, Yanke AB, Fortier L, Cole BJ. Effect of leukocyte concentration on the efficacy of platelet-rich plasma in the treatment of knee osteoarthritis. Am J Sports Med. 2016;44:792–800. Recent review outlining that leukocyte-poor preparations of PRP (LP-PRP) are superior in treating knee OA symptoms compared to leukocyte-rich PRP (LR-PRP) preparations.

    Google Scholar 

  87. 87.

    Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, et al. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012;40:2822–7.

    PubMed  Google Scholar 

  88. 88.

    Sánchez M, Fiz N, Azofra J, Usabiaga J, Aduriz Recalde E, Garcia Gutierrez A, et al. A randomized clinical trial evaluating plasma rich in growth factors (PRGF-Endoret) versus hyaluronic acid in the short-term treatment of symptomatic knee osteoarthritis. Arthroscopy. 2012;28:1070–8.

    PubMed  Google Scholar 

  89. 89.

    Patel S, Dhillon MS, Aggarwal S, Marwaha N, Jain A. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013;41:356–64.

    PubMed  Google Scholar 

  90. 90.

    Hart R, Safi A, Komzák M, Jajtner P, Puskeiler M, Hartová P. Platelet-rich plasma in patients with tibiofemoral cartilage degeneration. Arch Orthop Trauma Surg. 2013;133:1295–301.

    PubMed  Google Scholar 

  91. 91.

    Filardo G, Di Matteo B, Di Martino A, Merli ML, Cenacchi A, Fornasari P, et al. Platelet-rich plasma intra-articular knee injections show no superiority versus viscosupplementation: a randomized controlled trial. Am J Sports Med. 2015;43:1575–82.

    PubMed  Google Scholar 

  92. 92.

    Civinini R, Nistri L, Martini C, Redl B, Ristori G, Innocenti M. Growth factors in the treatment of early osteoarthritis. Clin Cases Miner Bone Metab. 2013;10:26–9.

    PubMed  PubMed Central  Google Scholar 

  93. 93.

    Carballo CB, Nakagawa Y, Sekiya I, Rodeo SA. Basic science of articular cartilage. Clin Sports Med. 2017;36:413–25.

    PubMed  Google Scholar 

  94. 94.

    Rayegani SM, Raeissadat SA, Taheri MS, Babaee M, Bahrami MH, Eliaspour D, et al. Does intra articular platelet rich plasma injection improve function, pain and quality of life in patients with osteoarthritis of the knee? A randomized clinical trial. Orthop Rev [Internet]. 2014 [cited 2018 Mar 12];6. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4195987/.

  95. 95.

    Braun HJ, Kim HJ, Chu CR, Dragoo JL. The effect of platelet-rich plasma formulations and blood products on human s implications for intra-articular injury and therapy. Am J Sports Med. 2014;42:1204–10.

    PubMed  PubMed Central  Google Scholar 

  96. 96.

    Rowden A, Dominici P, D’Orazio J, Manur R, Deitch K, Simpson S, et al. Double-blind, randomized, placebo-controlled study evaluating the use of platelet-rich plasma therapy (PRP) for acute ankle sprains in the emergency department. J Emerg Med. 2015;49:546–51.

    PubMed  Google Scholar 

  97. 97.

    Laver L, Carmont MR, McConkey MO, Palmanovich E, Yaacobi E, Mann G, et al. Plasma rich in growth factors (PRGF) as a treatment for high ankle sprain in elite athletes: a randomized control trial. Knee Surg Sports Traumatol Arthrosc. 2015;23:3383–92.

    PubMed  Google Scholar 

  98. 98.

    Hamid MS A, Mohamed Ali MR, Yusof A, George J, Lee LPC. Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial. Am J Sports Med. 2014;42:2410–8.

    Google Scholar 

  99. 99.

    Reurink G, Goudswaard GJ, Moen MH, Weir A, Verhaar JAN, Bierma-Zeinstra SMA, et al. Platelet-rich plasma injections in acute muscle injury. N Engl J Med. 2014;370:2546–7.

    CAS  PubMed  PubMed Central  Google Scholar 

  100. 100.

    Marcazzan S, Taschieri S, Weinstein RL, Del Fabbro M. Efficacy of platelet concentrates in bone healing: a systematic review on animal studies—part B: large-size animal models. Platelets. 2017;1–9.

  101. 101.

    Dulgeroglu TC, Metineren H. Evaluation of the effect of platelet-rich fibrin on long bone healing: an experimental rat model. Orthopedics. 2017;40:e479–84.

    PubMed  Google Scholar 

  102. 102.

    Gianakos A, Zambrana L, Savage-Elliott I, Lane JM, Kennedy JG. Platelet-rich plasma in the animal long-bone model: an analysis of basic science evidence. Orthopedics. 2015;38:e1079–90.

    PubMed  Google Scholar 

  103. 103.

    Guzel Y, Karalezli N, Bilge O, Kacira BK, Esen H, Karadag H, et al. The biomechanical and histological effects of platelet-rich plasma on fracture healing. Knee Surg Sports Traumatol Arthrosc. 2015;23:1378–83.

    PubMed  PubMed Central  Google Scholar 

  104. 104.

    Roffi A, Di Matteo B, Krishnakumar GS, Kon E, Filardo G. Platelet-rich plasma for the treatment of bone defects: from pre-clinical rational to evidence in the clinical practice. A systematic review. Int Orthop. 2017;41:221–37.

    PubMed  Google Scholar 

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Correspondence to Jason L. Dragoo.

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Conflict of Interest

Dr. Dragoo reports consultancy for Ossur, Genzyme, Depuy/Mitek, Linvatec, Miximed, Zimmer, Harvet/Terumo, and Flexion Therapeutics, grants from Ossur, and educational funding from Linvatec, Smith and Nephew, Breg, and Ossur. All other authors declare no conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Protein-Rich Plasma: From Bench to Treatment of Arthritis

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Le, A.D.K., Enweze, L., DeBaun, M.R. et al. Current Clinical Recommendations for Use of Platelet-Rich Plasma. Curr Rev Musculoskelet Med 11, 624–634 (2018). https://doi.org/10.1007/s12178-018-9527-7

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Keywords

  • Platelet-rich plasma
  • PRP
  • Orthobiologics
  • Regenerative medicine
  • Tendinopathy
  • Osteoarthritis