Platelet-rich plasmas (PRP) in tendon and joint pathologies of the upper limb
Posted by prpmed on March 23rd, 2021
What is PRP Platelet Rich Plasma?
The plasma is a serum including clotting factors and proteins.
The platelets are cells coreless with mitochondria, microtubules and alpha granules .
There are between 50 and 80 alpha granules per strip. These alpha granules synthesize, store and release around thirty bioactive proteins, which are growth factors whose function is hemostasis (blood coagulation) and tissue healing .
How do growth factors work?
Following tissue damage , the repair process takes place in 3 phases .
First, tissue inflammation is initiated by the platelets . During this phase, platelets release a large amount of growth factors.
In the second phase, these growth factors activate cell and matrix (tissue around cells) proliferation. The architecture of the scarred tissue is done in an anarchic way.
Finally, this cascade of growth factors leads to tissue remodeling , that is to say a reorganization of scar tissue.
How do you prepare and use PRPs?
The preparation of PRP requires a blood sample with PRP-Set, which is centrifuged with PRP-centrifuge to separate the Platelet Poor Plasma (PPP representing 5% of the blood) on the surface, the Platelet and Fibrinogen Rich Plasma (PRP representing 40% of the blood) in the middle, granulocytes and leukocytes at the bottom of the PRP tubes (accounting for 55% of the blood).
What are the different types of PRP?
Depending on the material used and the single or double centrifugation, the composition of PRP, used in osteo-ligamentous pathologies, can be variable in terms of the concentration of platelets and growth factors. In addition, it must not contain granulocytes or leukocytes and must not be coagulated , otherwise the healing cascade is disturbed.
What precautions should be taken when injecting PRP?
Nonsteroidal anti-inflammatory drugs (NSAIDs) should not be used the days before and two weeks after the injection of PRP, as they may inhibit the action of prostaglandins and thus the stimulatory effects of PRP. Local anti-inflammatory treatments , including the application of a cold pack, should also be avoided . In case of pain, paracetamol will be used.
What are PRPs used for?
It is known that in vitro PRPs have a favorable action on bone, cartilage and tendon cells.
The use of PRP in osteoarthritis
For now, there is no study on osteoarthritis of the shoulder or elbow, but many studies have been done for the knee and seem extrapolable.
A meta-analysis of the use of PRP in the pathologies of osteoarthritis was carried out on a series of 20 in vivo and in vitro studies of level 1 (best level). This study shows that the following effects of PRP on osteoarthritis:
PRP are therefore effective in the early stages of osteoarthritis . In the more advanced stages of osteoarthritis, PRPs are not very effective because the cartilage is too worn out to be able to regenerate.
PRP versus hyaluronic acid in osteoarthritis of the shoulder
Hyaluronic acid has been used in the treatment of early stage osteoarthritis for many years. It is now put in competition with the PRPs.
The use of PRP seems possible in osteoarthritis (osteoarthritis of the shoulder). In fact, a study of 10 patients suffering from osteoarthritis of the knee , showed that PRP have greater efficacy and more stable effects over time than hyaluronic acid. To date, there is no specific study for osteoarthritis of the shoulder, but these results are probably extrapolable.
PRP and torn cuff tendons
Some surgeons use PRP to speed up tendon healing after cuff repair.
A meta-analysis of 70 studies was performed (3); only 5 studies were retained as being significant. The findings indicate that at present there is no clinical improvement in recovery after use of PRP. On the other hand, it would seem that we find fewer re-ruptures after MRI control in the groups using PRP for lesions of small or intermediate size.
PRP and tendonitis of the cuff
So far, few studies have been carried out on cuff tendinopathies, but if we correlate with the many studies done for epicondylitis, PRP should be effective in calcifying and non-calcifying tendinopathies.
However, a study carried out on 20 patients does not seem to show clinical improvement.
PRP and tendinopathy of the elbow (epicondylitis)
A meta-analysis of 9 randomized level 1 studies (best level) shows clinical improvement with the use of PRP in elbow tendinopathies
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Joined: March 23rd, 2021
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