Andrew J. Sheean, M.D., Adam W. Anz, M.D., and James P. Bradley, M.D.
The authors report the following potential conflicts of interest or sources of funding: A.J.S. reports personal fees from Arthroscopy and grants from Embody, Inc., outside the submitted work. A.W.A. reports grants and personal fees from Arthrex, personal fees from Ossur, and grants from KLSMC Stem Cell, outside the submitted work. J.P.B. reports royalties from Arthrex, outside the submitted work. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Received February 16, 2021; accepted July 6, 2021.
Address correspondence to Andrew J. Sheean, M.D., San Antonio Military Medical Center, San Antonio, Texas 78234 U.S.A. E-mail: ajsheean@gmail. com
Published by Elsevier on behalf of the Arthroscopy Association of North America
0749-8063/21978/$36.00
https://doi.org/10.1016/j.arthro.2021.07.003
Abstract:
Platelet-rich plasma (PRP) is perhaps the most widely studied of the biologic therapies, with an
ever-growing body of evidence supporting its safety and efficacy in decreasing inflammation and pain and
promoting healing in the setting of both nonoperative and operative treatments. PRP is produced by the
centrifugation of whole blood, isolating its constituent parts based on their unique densities. These density
gradients can be selectively harvested so as to obtain different concentrations of various blood product
components, such as platelets and leukocytes. A precise and consistent method for describing the essential
characteristics of different PRP formulations is critical for both practical and research purposes. The concentration
of platelets, method of activation, and the total number of red blood cells (RBCs), white blood
cells (WBCs), and neutrophils relative to baseline values are all of particular importance in accurately
describing a PRP formulation. The biologic activity of PRP is manifold: platelet α granules promote the
release of various growth factors, including vascular endothelial growth factor and tissue growth factor b,
while inflammation is modulated through inhibition of the nuclear factor-κB pathway. PRP has been
convincingly shown to be efficacious in the setting of patellar tendinopathies, knee osteoarthritis, and
lateral epicondylitis. In fact, several recent randomized controlled trials have demonstrated the superiority
of PRP over both corticosteroids and hyaluronic acid in treating knee OA-related symptoms. There is also
substantial promise for the utility of PRP in treating partial hamstring tears and as an adjunct to rotator cuff
(RC) repair, especially in the setting of small- to medium-sized tears, where it appears to exert substantial
analgesic effects and promote enhanced rates of RC repair healing.
Bibliography
Anz AW, Parsa RS, Romero-Creel MF, et al. Exercise-mobilized
platelet-rich plasma: Short-term exercise increases
stem cell and platelet concentrations in platelet-rich
plasma. Arthroscopy 2019;35:192-200.
Bendinelli P, Matteucci E, Dogliotti G, et al. Molecular basis of
anti-inflammatory action of platelet-rich plasma on human
chondrocytes: Mechanisms of NF-kB inhibition via HGF.
J Cell Physiol 2010;225:757-766.
Boswell SG, Cole BJ, Sundman EA, Karas V, Fortier LA.
Platelet-rich plasma: A milieu of bioactive factors. Arthroscopy
2012;28:429-439.
Bradley JP, Lawyer TJ, Ruef S, Towers JD, Arner JW. Plateletrich
plasma shortens return to play in National Football
League players with acute hamstring injuries. Orthop J
Sports Med 2020;8:2325967120911731.
Cole BJ, Karas V, Hussey K, Pilz K, Fortier LA. Hyaluronic
acid versus platelet-rich plasma: A prospective, doubleblind
randomized controlled trial comparing clinical outcomes
and effects on intra-articular biology for the
treatment of knee osteoarthritis. Am J Sports Med 2017;45:
339-346.
Cross JA, Cole BJ, Spatny KP, et al. Leukocyte-reduced
platelet-rich plasma normalizes matrix metabolism in torn human rotator cuff tendons. Am J Sports Med 2015;43:
2898-2906.
DeLong JM, Russell RP,Mazzocca AD. Platelet-rich plasma: The
PAW classification system. Arthroscopy 2012;28:998-1009.
Hurley ET, Lim Fat D, Moran CJ, Mullett H. The efficacy of
platelet-rich plasma and platelet-rich fibrin in arthroscopic
rotator cuff repair: A meta-analysis of randomized
controlled trials. Am J Sports Med 2019;47:753-761.
Hurley ET, Colasanti CA, Anil U, et al. The effect of plateletrich
plasma leukocyte concentration on arthroscopic rotator
cuff repair: A network meta-analysis of randomized
controlled trials. Am J Sports Med 2020:363546520975435.
Lamplot JD, Rodeo SA, Brophy RH. A practical guide for the
current use of biologic therapies in sports medicine. Am J
Sports Med 2020;48:488-503.
Mishra AK, Skrepnik NV, Edwards SG, et al. Efficacy of plateletrich
plasma for chronic tennis elbow: a double-blind, prospective,
multicenter, randomized controlled trial of 230 patients. Am J Sports Med 2014;42;463-471.
Park YB, Kim JH, Ha CW, Lee DH. Clinical efficacy of plateletrich plasma injection and its association with growth factors in the treatment of mild to moderate knee osteoarthritis: A randomized double-blind controlled clinical trial as compared with hyaluronic acid. Am J Sports Med 2021;49:487-496.
Scott A, LaPrade RF, Harmon KG, et al. Platelet-rich plasma for patellar tendinopathy: A randomized controlled trial of leukocyte-rich PRP or leukocyte-poor PRP versus saline. Am J Sports Med 2019;47:1654-1661.
Sundman EA, Cole BJ, Karas V, et al. The antiinflammatory and matrix restorative mechanisms of platelet-rich plasma in osteoarthritis. Am J Sports Med 2014;42:35-41.
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