Platelet rich plasma Injection grafts for musculoskeletal injuries：a review（6）.
Summary
In summary, for over 20 years PRP has been used safely in a variety of conditions with promising implications. Unfortunately, most studies to date are anecdotal or involve small sample sizes. Undoubtedly we are seeing increased clinical use of PRP, however more clinical trials are certainly needed. Little is documented in the literature regarding the expected timeframe of tendon healing post-PRP injection. Also, there are no studies to date that review the need of post-PRP injection rehabilitation, nor are there any protocols. However, it is assumed that Physical/Occupational therapy and restoring the kinetic chain will help facilitate recovery post injection.
The authors are currently expanding PRP injection applications from tendon injuries to other persistent ailments including greater trochanteric bursitis and knee osteoarthritis with favorable results. The authors also have had success in injecting professional soccer athletes with acute MCL knee injuries in an effort to accelerate their return to play (Fig. 8). Further understanding of this promising treatment is required to determine which particular diagnoses are amenable to PRP therapy. The authors will report results on this topic in the near future.
Fig. 8
Ultrasound guided knee MCL injection/graft
The use of autologous Growth factors in the form of PRP may be just the beginning of a new medical frontier known as “Orthobiologics.” First generation injectables such as Visco-supplementation have been successful in the treatment of pain for patients with osteoarthritis of the knee. These injections represent a non-biologic effort to influence the biochemical environment of the joint.
A second generation of injectables is now available with PRP. This technology provides delivery of a highly concentrated potent cocktail of Growth factors to stimulate healing. TGF-b, contained in PRP has been linked to Chondrogenesis in cartilage repair [43]. New reports presented at the 2007 International Cartilage Repair Society Meeting in Warsaw indicate PRP enhancement of Chondrocyte cell proliferation and positive clinical effects on degenerative knee cartilage [44, 45]. Anitua and Sanchez recently demonstrated increased Hyluronic acid concentration balancing angiogenesis in ten osteoarthritic knee patients [46]. Wu et al. documented PRP promotion of Chondrogenesis as an injectable scaffold while seeded with chondrocytes in rabbit ears. Hard knobbles were found and seen on MRI, as well as histologic analysis and staining which confirmed cartilage growth [47].
Future generations of biologic injectables may target specific cells, rather than providing an assortment of non-specific healing properties. Currently clinical trials of intra-articular use of growth factor BMP 7 (OPI) are underway. Soft tissue applications of BMP7 (OPI) are also in its early stages. Bone marrow aspirate stem cell injections are seeing increased clinical use as well. Ultimately, Stem cell therapy represents the greatest biologic healing potential.
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