The role of platelet-rich plasma in inducing musculoskeletal tissue healing

Abstract

Background: 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.

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: healing; ligament; osteoarthritis; platelet-rich plasma; tendon.

Figures

Fig. 1

Coronal inversion recovery images of an elbow in a 57-year-old man treated with PRP injection. The preoperative MRI (a) demonstrates severe degeneration of the common extensor origin (thick black arrow) with a partial thickness intrasubstance tear (thin black arrow) and adjacent extracapsular soft tissue edema (short black arrow). On the follow-up MRI (b) performed 3 months after treatment with PRP, there is only mild tendinosis (white arrow) with resolution of the previously seen partial thickness tear

Fig. 2

Coronal FSE knee images in a 65-year-old woman treated with intra-articular PRP injection. The baseline MRI (a) demonstrates high-grade partial thickness cartilage wear over the medial femoral condyle (thick black arrow) and medial tibial plateau (modified Outerbridge score 3). There are medial and lateral compartment osteophytes (thin black arrows). On the follow-up MRI (b) performed 1 year after PRP injection, the appearance of the cartilage is unchanged