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Researchers describe lack of homogeneity in PRP tendon studies
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TORONTO — There is a need for increased consistency in how researchers report the results of tendon healing with platelet-rich plasma studies, according to a presenter here at the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine Congress.
“We’d like to see an increased reporting of such factors as type of platelet processing, white cell count and growth factors and leukocytes within the [platelet-rich plasma] PRP, ” Nikolas Baksh, BS, said.
Nikolas Baksh
In the study, researchers screened PubMed/Medline and EMBASE databases in June 2012 for basic science studies, including studies with controls that used PRP for tendon healing. Of 31 full-text articles that met the study inclusion criteria Baksh and colleagues established, 11 studies examined the effect of PRP on growth factor expression. Ten of the studies showed an increase in growth factor expression.
“Nine studies looked at the effects of PRP on cell proliferation and, of those, eight [studies] showed significant increases in cell proliferation with PRP treatment,” Baksh said.
He detailed the studies included in their analysis based on which ones involved histological assessments to determine the amount of collagen deposition on tendons with PRP and other factors associated with PRP use investigators determined were standard criteria for this biologic substance.
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“So while PRP showed some potential beneficial effects, we thought there was a lack of homogeneity in the reporting of PRP preparation in the literature,” Baksh said. “Only 20 of the 31 studies we looked at actually reported the actual platelet concentration within the PRP.”
Reference:
Baksh N. Paper #111. Presented at: The International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine Congress; May 12-16, 2013; Toronto.
Disclosure: Baksh has no relevant financial disclosures.
Perspective
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Ramon Cugat, MD, PhD
We need to qualify which kind of platelet rich plasma (PRP) we are using — there are many kinds of PRP — because we need to know which is the best of these PRPs. But nowadays, we know a few things. For example, one of the problems is when we inject PRP with leukocytes inside the knee joint. We can have problems with effusion, inflammation and pain. If we increase a lot the platelets and we inject them in a muscle tear, then that can lead to a problem of increased fibrous tissue. The biology and biochemistry explains the release of TGF beta1 in this way and increases collagen 1 instead of collagen 3 and then this creates more fibrosity.
For athletes, such as soccer players with hamstring injuries, this group of muscles tends to have a lot of lesions. If we inject a lot of PRP with platelets, the result can be a large fibrosis and then complications and re-tear because it is not good tissue. The idea to use lots of growth factors is actually healing plus to foster good tissue of a high quality. In this way, we have better quality tissue.
There are many things we know. I agree we need to do more clinical studies, but I think we need to keep working on research and clinical application trials. I think the future is regenerative medicine because nowadays in orthopaedics, we pay attention to anatomy, biomechanics, but I think we need to pay more attention to the biology and biochemistry.Click Here to Manage Email Alerts