Use Of Platelet-Rich Plasma In Orthopedics *
The increasing use of platelet-rich plasma (PRP) in orthopedics presents significant opportunities—as well as significant questions—about appropriate clinical applications for this developing therapy.
PRP was initially developed in the 1970s; recent technologic advances have enabled the administration of PRP to move from the hospital setting into outpatient and ambulatory surgical centers…even into physicians’ offices.
Although PRP therapy seems quite promising in several areas, it is not appropriate in all cases. A clear understanding of the repair response, the development of PRP therapy, and the variables that may affect the effectiveness of PRP therapy is necessary to make informed clinical judgments on its use.
The Repair Response
The repair response of musculoskeletal tissues generally starts with the formation of a blood clot and degranulation of platelets, which releases growth factors and cytokines at the site. This microenvironment results in chemotaxis of inflammatory cells as well as the activation and proliferation of local progenitor cells. In most cases, fibroblastic scar tissue is formed. In some settings, however, such as in a fracture callus, these conditions can also facilitate the formation of new bone tissue.
Use With Care
In summary, available data suggest that PRP may be valuable in enhancing soft-tissue repair and in wound healing.15 However, the clinical role of PRP in bone repair remains controversial. PRP is not uniformly successful as an adjuvant to bone grafting procedures. PRP may promote or inhibit bone formation, depending on the setting in which it is used and the quality of the PRP.