PRP in Tendons and Other Non-bone Tissues

  • Sebastiano Vasta
  • Rocco Papalia
  • Vincenzo Denaro
  • Nicola Maffulli


Though highly debated, platelet rich plasma (PRP) has been increasingly used in all the field orthopaedic and trauma surgery. Its mechanism of action is still unclear and as we no clear evidences of its effectiveness are available.


Hyaluronic Acid Rotator Cuff Knee Osteoarthritis Platelet Rich Plasma Eccentric Exercise 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Andia I, Latorre PM, Gomez MC, Burgos-Alonso N, Abate M, Maffulli N. Platelet-rich plasma in the conservative treatment of painful tendinopathy: a systematic review and meta-analysis of controlled studies. Br Med Bull. 2014;110(1):99–115. doi: 10.1093/bmb/ldu007.CrossRefPubMedGoogle Scholar
  2. 2.
    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. doi: 10.1267/THRO04010004.PubMedGoogle Scholar
  3. 3.
    Anitua E, Andia I, Sanchez M, Azofra J, del Mar Zalduendo M, de la Fuente M, Nurden P, Nurden AT. Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res Off Publ Orthop Res Soc. 2005;23(2):281–6. doi: 10.1016/j.orthres.2004.08.015.CrossRefGoogle Scholar
  4. 4.
    Antuna S, Barco R, Martinez Diez JM, Sanchez Marquez JM. Platelet-rich fibrin in arthroscopic repair of massive rotator cuff tears: a prospective randomized pilot clinical trial. Acta Orthop Belg. 2013;79(1):25–30.PubMedGoogle Scholar
  5. 5.
    Barber FA, Hrnack SA, Snyder SJ, Hapa O. Rotator cuff repair healing influenced by platelet-rich plasma construct augmentation. Arthroscopy J Arthroscopic Relat Surg Off Publ Arthroscopy Assoc North Am Int Arthroscopy Assoc. 2011;27(8):1029–35. doi: 10.1016/j.arthro.2011.06.010.CrossRefGoogle Scholar
  6. 6.
    Bergeson AG, Tashjian RZ, Greis PE, Crim J, Stoddard GJ, Burks RT. Effects of platelet-rich fibrin matrix on repair integrity of at-risk rotator cuff tears. Am J Sports Med. 2012;40(2):286–93. doi: 10.1177/0363546511424402.CrossRefPubMedGoogle Scholar
  7. 7.
    Boileau P, Brassart N, Watkinson DJ, Carles M, Hatzidakis AM, Krishnan SG. Arthroscopic repair of full-thickness tears of the supraspinatus: does the tendon really heal? J Bone Joint Surg Am. 2005;87(6):1229–40. doi: 10.2106/JBJS.D.02035.CrossRefPubMedGoogle Scholar
  8. 8.
    Castricini R, Longo UG, De Benedetto M, Panfoli N, Pirani P, Zini R, Maffulli N, Denaro V. Platelet-rich plasma augmentation for arthroscopic rotator cuff repair: a randomized controlled trial. Am J Sports Med. 2011;39(2):258–65. doi: 10.1177/0363546510390780.CrossRefPubMedGoogle Scholar
  9. 9.
    Cerza F, Carni S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012;40(12):2822–7. doi: 10.1177/0363546512461902.CrossRefPubMedGoogle Scholar
  10. 10.
    Chen L, Dong SW, Liu JP, Tao X, Tang KL, Xu JZ. Synergy of tendon stem cells and platelet-rich plasma in tendon healing. J Orthop Res Off Publ Orthop Res Soc. 2012;30(6):991–7. doi: 10.1002/jor.22033.CrossRefGoogle Scholar
  11. 11.
    Chillemi C, Petrozza V, Garro L, Sardella B, Diotallevi R, Ferrara A, Gigante A, Di Cristofano C, Castagna A, Della Rocca C. Rotator cuff re-tear or non-healing: histopathological aspects and predictive factors. Knee Surg Sports Traumatol Arthroscopy Off J ESSKA. 2011;19(9):1588–96. doi: 10.1007/s00167-011-1521-1.CrossRefGoogle Scholar
  12. 12.
    Creaney L, Wallace A, Curtis M, Connell D. 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. 2011;45(12):966–71. doi: 10.1136/bjsm.2010.082503.CrossRefPubMedGoogle Scholar
  13. 13.
    de Jonge S, de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL. 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(8):1623–9. doi: 10.1177/0363546511404877.CrossRefPubMedGoogle Scholar
  14. 14.
    Di Matteo B, Filardo G, Kon E, Marcacci M. Platelet-rich plasma: evidence for the treatment of patellar and Achilles tendinopathy-a systematic review. Musculoskelet Surg. 2014. doi: 10.1007/s12306-014-0340-1.PubMedGoogle Scholar
  15. 15.
    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(3):610–8. doi: 10.1177/0363546513518416.CrossRefPubMedGoogle Scholar
  16. 16.
    Filardo G, Kon E, Di Martino A, Di Matteo B, Merli ML, Cenacchi A, Fornasari PM, Marcacci M. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskelet Disord. 2012;13:229. doi: 10.1186/1471-2474-13-229.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Filardo G, Kon E, Di Matteo B, Pelotti P, Di Martino A, Marcacci M. Platelet-rich plasma for the treatment of patellar tendinopathy: clinical and imaging findings at medium-term follow-up. Int Orthop. 2013;37(8):1583–9. doi: 10.1007/s00264-013-1972-8.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Franceschi F, Papalia R, Franceschetti E, Paciotti M, Maffulli N, Denaro V. Platelet-rich plasma injections for chronic plantar fasciopathy: a systematic review. Br Med Bull. 2014;112(1):83–95. doi: 10.1093/bmb/ldu025.CrossRefPubMedGoogle Scholar
  19. 19.
    Galatz LM, Ball CM, Teefey SA, Middleton WD, Yamaguchi K. The outcome and repair integrity of completely arthroscopically repaired large and massive rotator cuff tears. J Bone Joint Surg Am. 2004;86-A(2):219–24.PubMedGoogle Scholar
  20. 20.
    Gumina S, Campagna V, Ferrazza G, Giannicola G, Fratalocchi F, Milani A, Postacchini F. Use of platelet-leukocyte membrane in arthroscopic repair of large rotator cuff tears: a prospective randomized study. J Bone Joint Surg Am. 2012;94(15):1345–52. doi: 10.2106/JBJS.K.00394.CrossRefPubMedGoogle Scholar
  21. 21.
    Jo CH, Kim JE, Yoon KS, Lee JH, Kang SB, Lee JH, Han HS, Rhee SH, Shin S. Does platelet-rich plasma accelerate recovery after rotator cuff repair? A prospective cohort study. Am J Sports Med. 2011;39(10):2082–90. doi: 10.1177/0363546511413454.CrossRefPubMedGoogle Scholar
  22. 22.
    Jo CH, Shin JS, Lee YG, Shin WH, Kim H, Lee SY, Yoon KS, Shin S. Platelet-rich plasma for arthroscopic repair of large to massive rotator cuff tears: a randomized, single-blind, parallel-group trial. Am J Sports Med. 2013;41(10):2240–8. doi: 10.1177/0363546513497925.CrossRefPubMedGoogle Scholar
  23. 23.
    Kim E, Lee JH. Autologous platelet-rich plasma versus dextrose prolotherapy for the treatment of chronic recalcitrant plantar fasciitis. PM & R J Injury Funct Rehabil. 2014;6(2):152–8. doi: 10.1016/j.pmrj.2013.07.003.CrossRefGoogle Scholar
  24. 24.
    Krogh TP, Fredberg U, Stengaard-Pedersen K, Christensen R, Jensen P, Ellingsen T. Treatment of lateral epicondylitis with platelet-rich plasma, glucocorticoid, or saline: a randomized, double-blind, placebo-controlled trial. Am J Sports Med. 2013;41(3):625–35. doi: 10.1177/0363546512472975.CrossRefPubMedGoogle Scholar
  25. 25.
    Li M, Zhang C, Ai Z, Yuan T, Feng Y, Jia W. Therapeutic effectiveness of intra-knee-articular injection of platelet-rich plasma on knee articular cartilage degeneration. Zhongguo xiu fu chong jian wai ke za zhi = Zhongguo xiufu chongjian waike zazhi = Chin J Reparative Reconst Surg. 2011;25(10):1192–6.Google Scholar
  26. 26.
    Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot Ankle Int. 2014;35(4):313–8. doi: 10.1177/1071100713519778.CrossRefPubMedGoogle Scholar
  27. 27.
    Omar ASIM, Ahmed AS, et al. Local injection of autologous platelet rich plasma and corticosteroid in treatment of lateral epicondylitis and plantar fasciitis: randomized clinical trial. Egypt Rheumatol. 2012;34:43–9.CrossRefGoogle Scholar
  28. 28.
    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(2):356–64. doi: 10.1177/0363546512471299.CrossRefPubMedGoogle Scholar
  29. 29.
    Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza P. Platelet rich plasma in arthroscopic rotator cuff repair: a prospective RCT study, 2-year follow-up. J Shoulder Elbow Surg/Am Shoulder Elbow Surg [et al]. 2011;20(4):518–28. doi: 10.1016/j.jse.2011.02.008.CrossRefGoogle Scholar
  30. 30.
    Randelli P, Spennacchio P, Ragone V, Arrigoni P, Casella A, Cabitza P. Complications associated with arthroscopic rotator cuff repair: a literature review. Musculoskelet Surg. 2012;96(1):9–16. doi: 10.1007/s12306-011-0175-y.CrossRefPubMedGoogle Scholar
  31. 31.
    Rodeo SA, Delos D, Williams RJ, Adler RS, Pearle A, Warren RF. The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: a prospective, randomized clinical study. Am J Sports Med. 2012;40(6):1234–41. doi: 10.1177/0363546512442924.CrossRefPubMedGoogle Scholar
  32. 32.
    Ruiz-Moneo P, Molano-Munoz J, Prieto E, Algorta J. Plasma rich in growth factors in arthroscopic rotator cuff repair: a randomized, double-blind, controlled clinical trial. Arthroscopy J Arthroscopic Relat Surg Off Publ Arthroscopy Assoc North Am Int Arthroscopy Assoc. 2013;29(1):2–9. doi: 10.1016/j.arthro.2012.08.014.CrossRefGoogle Scholar
  33. 33.
    Schnabel LV, Mohammed HO, Miller BJ, McDermott WG, Jacobson MS, Santangelo KS, Fortier LA. Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons. J Orthop Res Off Publ Orthop Res Soc. 2007;25(2):230–40. doi: 10.1002/jor.20278.CrossRefGoogle Scholar
  34. 34.
    Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med. 2011;39(10):2130–4. doi: 10.1177/0363546511417113.CrossRefPubMedGoogle Scholar
  35. 35.
    Tohidnezhad M, Varoga D, Wruck CJ, Brandenburg LO, Seekamp A, Shakibaei M, Sonmez TT, Pufe T, Lippross S. Platelet-released growth factors can accelerate tenocyte proliferation and activate the anti-oxidant response element. Histochem Cell Biol. 2011;135(5):453–60. doi: 10.1007/s00418-011-0808-0.CrossRefPubMedGoogle Scholar
  36. 36.
    Trappey GJ, Gartsman GM. A systematic review of the clinical outcomes of single row versus double row rotator cuff repairs. J Shoulder Elbow Surg/Am Shoulder Elbow Surg [et al]. 2011;20(2 Suppl):S14–9. doi: 10.1016/j.jse.2010.12.001.CrossRefGoogle Scholar
  37. 37.
    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(4):795–803. doi: 10.1177/0363546513475345.CrossRefPubMedGoogle Scholar
  38. 38.
    Wang X, Qiu Y, Triffitt J, Carr A, Xia Z, Sabokbar A. Proliferation and differentiation of human tenocytes in response to platelet rich plasma: an in vitro and in vivo study. J Orthop Res Off Publ Orthop Res Soc. 2012;30(6):982–90. doi: 10.1002/jor.22016.CrossRefGoogle Scholar
  39. 39.
    Weber SC, Kauffman JI, Parise C, Weber SJ, Katz SD. Platelet-rich fibrin matrix in the management of arthroscopic repair of the rotator cuff: a prospective, randomized, double-blinded study. Am J Sports Med. 2013;41(2):263–70. doi: 10.1177/0363546512467621.CrossRefPubMedGoogle Scholar
  40. 40.
    Zhang J, Middleton KK, Fu FH, Im HJ, Wang JH. HGF mediates the anti-inflammatory effects of PRP on injured tendons. PLoS One. 2013;8(6), e67303. doi: 10.1371/journal.pone.0067303.CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Zhang Q, Ge H, Zhou J, Cheng B. Are platelet-rich products necessary during the arthroscopic repair of full-thickness rotator cuff tears: a meta-analysis. PLoS One. 2013;8(7), e69731. doi: 10.1371/journal.pone.0069731.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag London 2016

Authors and Affiliations

  • Sebastiano Vasta
    • 1
  • Rocco Papalia
    • 1
  • Vincenzo Denaro
    • 1
  • Nicola Maffulli
    • 2
    • 3
  1. 1.Department of Orthopaedic and Trauma SurgeryCampus Bio-Medico University of RomeRomeItaly
  2. 2.Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and DentistryUniversity of SalernoSalernoItaly
  3. 3.Centre for Sports and Exercise Medicine, Barts and London School of Medicine and DentistryQueen Mary University of LondonLondonUK

Personalised recommendations