Platelet rich plasma (PRP) treatment in orthopaedics and trauma – MUSCLE
The administration of anti- inflammatory medication may alleviate the pain, however there is evidence that this medication interferes in the healing capacity of the muscle tissue. Anti- inflammatory drugs can inhibit the fusion of the important muscle cells, thus effecting proper healing.
According to Shen et al. (2008) growth factors along with inflammation cells regulate the inflammatory phase of skeletal muscle healing. The transforming growth factors can also work synergistically to balance the level of scar tissue during muscle healing.
The peak of muscle injury coincides with the period of maximum neutrophil (Inflammatory cells) migration, which occurs from 1 to 2 h after the initial phase of the injury. Then pro-inflammatory cells migrate as an anti-inflammatory configuration as muscle regeneration begins. During the regenerative phase, platelet concentrations has a fundamental role in stimulating muscle cells to the injured site.
A study on muscle laceration reported that a growth factor released improved muscle healing and increased rapid contraction force within 1 month. The use of own platelets in the treatment of muscle injuries caused by impact in the calf resulted in an increase of muscle cell activation and inter cellular width.
Based on this study, Sánchez et al. (2005) evaluated, in 20 sports muscle injury patients, the clinical benefits of the application of growth factor associated with rehabilitation therapy. The results showed a decrease in pain and swelling, a complete recovery of functional capacities before the expected time, and regeneration of the muscle tissue according to imaging.
It was Harmon (2010) that reports that, PRP would accelerate the healing process, but in practice only some of the several types of platelet concentrate seem to be involved in this function. He suggests that application should occur in the first 24 h after muscle injury as an attempt to control the secondary inflammatory phase, associated with traditional procedures such as compression, elevation and local application of ice.
In one recent study participants were divided at random to receive either the PRP along with a rehabilitation programme, or only a rehabilitation programme. The main outcome of this study will be the time taken to return to games after the lesion. This study protocol proposes a strict assessment and with a significant potential for use with class 2 muscular lesions. If the efficacy of PRP is proved, such findings will bring great benefits for patients with similar lesions. More studies are necessary to establish the efficiency of and best protocols for using PRP in acute muscle injury treatment. But will be underway very soon and research is progressing at a massive rate.
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