Platelet rich plasma (PRP) in orthopaedics and traumatology. TENDON
PRP treatment is becoming increasingly popular clinically, with treatment applications for both soft and bone tissues. Many studies are currently published and further in action to establish increased knowledge of the power of this growth factors in healing.
The International Olympic Committee (IOC) met in 2008 to debate the prep- aration and application of PRP and published a consensus article in 2010 presenting information on the basic biology of platelets and mechanisms of growth factor action, methods of application and the most-recommended PRP products for different tissues, post-application recommendations, possible adverse effects, information on the relationship between PRP and anti-doping and suggestions for trials (RCT) in order to standardise clinical studies, which would allow significant conclusions and comparison between studies. The IOC article represents an important guide to PRP-related practices and studies for Sports Medicine.
Tendon
Many authors have discussed the efficiency of PRP for treating tendon issues, andhave obtained many positive results.
Recent studies using cultures of human cells also support the use of PRP for treating tendon problems. Studies have found that PRP not only stimulates the proliferation of human tendon cells and the total production of collagen, but also slightly increases the expression of inflammatory mediators.
The use of platelets isolated from autologous blood to release growth factors in an injured area is an increasingly- used alternative Regenerative Medicine. This technique has also been applied in rotator cuff tendon repair (shoulder tendon) and resulted mainly in increased local blood supply, which consequently improved healing.
Mishra and Pavelko (2006) demonstrated an improvement in the pain felt by 15 patients with chronic elbow tendinosis after a single application of platelet rich plasma. These patients were compared to a control group of five patients treated with bupivacaineand were evaluated after 8 weeks, 6 months and approximately 2 years. In 93 % of the cases there was a pain reduction in the PRP-treated group.
Furthermore, Sampson et al. (2011) used a single application of PRP associated with rehab therapy to successfully treat a severe injury to the Achilles tendon of a 71-year-old patient, thus avoiding surgical intervention. The positive results were confirmed by MRI analysis, and in 24 weeks the patient showed no symptoms and was able to resume daily activities.
The first randomized clinical study concerning the use of PRP in complete ruptures of the ankle tendon was published by Schepull et al. (2011). Note that in this study the platelet concentration used in the PRP was approximately 10 times higher than that found in the peripheral blood. When compared to similar studies, this quantity is much higher.
Peerbooms et al. (2010) carried out a double-blind study, in favour of the use of PRP in the treatment of chronic lateral epicondylitis (tennis elbow), when compared to injections of Corticosteroids. The 100 patients included in the study were randomly divided. The results showed that, according to the scores of visual analogue pain, the group treated with PRP showed a significant statistic improvement at 1 year, in comparison to the group treated with corticosteroids. The corticosteroid group was better at the beginning, but after, its condition declined, while the PRP group improved progressively. This study showed promising results in terms of pain scores, although a study of bigger dimensions would be necessary to confirm this result.
This study shows the effectiveness of PRP treatment for tendon problems, in the nature of Regenerative Medicine.