Uses of platelet rich plasma in Orthopedics

Abstract

SUMMARY AND CONCLUSION R egenerative Medicine is a rapidly evolving field in sports medicine and orthopaedic surgery. The ideal biologic tool would be effective, simple to use, inexpensive, safe and available immediately at the point of care. Platelet rich plasma (PRP) meets many of these criteria. PRP represents an emerging biotechnology in current tissue engineering and cellular therapy. It has applications in management of orthopaedic diseases, primarily for tendon and ligament repair, and cartilage resurfacing. Also, has a role in muscle injury and bone repair. PRP are first of all blood extracts obtained after various processing of a whole blood sample, mostly through centrifugation (one or two step centrifugation). The objective of the processing is to separate the blood components in order to discard elements considered as not usable (mostly the red blood cells, heavy and easily separated) and to gather and concentrate the elements that may be used for therapeutic applications (fibrinogen/fibrin, platelets, growth factors, leukocytes and other forms of circulating cells, in solution in liquid plasma). PRP initiate repairing mechanism by releasing locally acting growth factors through degranulation of the granules in platelets, which contain the synthesized and prepackaged growth factors. Also, it is important to note that growth factors are not the only elements present in significant concentrations in PRP, as proteins of the cytokine and chemokine families are known to be present in varying concentrations as well. The network of activated growth factors aid healing by attracting undifferentiated cells in the newly formed matrix and triggering cell division by inducing intracellular signaling pathways that lead to the production of proteins essential to the regenerative processes, such as cell proliferation, matrix formation, osteoid production, and collagen synthesis. Generally, PRP is considered safe with little side effects. PRP is autologous, therefore, potential for immunological reactions or transmission of infection is very low. As with any injection there is a possibility of infection, no relief of symptoms, and neurovascular injury. Scar tissue formation and calcification at the injection site are also remote risks. Contraindications in the use of PRP grafts include septicaemia, thrombocytopenia, platelet dysfunction syndrome, hypofibrinogenemia, history of corticosteroid injection at the treatment site or systemic use of corticosteroid within 2 weeks of the procedure, the routine use of nonsteroidal anti-inflammatory drugs within 48 h of the procedure, recent fever or illness, skin breakdown or rash at site of injection, history of active tumour, cancer or metastatic state, anaemia (Hgb < 10 g/dl), and active infection with Pseudomonas, Enterococcus, or Klebsiella. PRP is gaining popularity in the treatment of tendinopathy. From the multiple human trials done, it is now clear that PRP has a great effect on rotator cuff tendinopathy even if there is a small tear (less than 1 cm). Most of the trials reached that PRP injection resulted in safe, significant, sustained improvement of pain, function, and MRI outcomes in participants with refractory RCT. On the other hand, the results of using PRP in the arthroscopic repair of large or complete tear of the rotator cuff is not good. Most of the trials found that PRP gel application to arthroscopic rotator cuff repairs did not accelerate recovery with respect to pain, range of motion, strength, functional scores, or overall satisfaction, only there is decrease in retear rate.