Platelet-rich plasma | |
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![]() Platelet-rich plasma injection into the hand | |
MeSH | D053657 |
Platelet-rich plasma (PRP), also known as autologous conditioned plasma, is a concentrate of plasma protein derived from whole blood, centrifuged to remove red blood cells, but leaving platelets. Though promoted to treat an array of medical problems, evidence for benefit was mixed as of 2020, with some evidence for use in certain conditions and against use in other conditions. [1] [2] [3]
As a concentrated source of blood plasma and autologous conditioned plasma, PRP contains multiple growth factors and other cytokines that can stimulate healing of soft tissue and joints. There are some indications for use in sports medicine and orthopedics (acute muscle strains, tendinopathy, muscle-fascial injuries, and osteoarthritis [4] ), or dermatology (androgenic alopecia, wound healing, and skin rejuvenation) or even in proctology (fistula-in-ano [5] ). [6]
Various preparation protocols are used, with an underlying principle of concentrating platelets to 3–5 times physiological levels, then injecting this concentrate in the tissue where healing is desired. [7] Besides the use in clinical practice PRP has been utilized for various tissue engineering applications in the context of bone, cartilage, skin, and soft tissue repair. It has been reviewed to serve as a source for the "delivery of growth factors and/or cells within tissue-engineered constructs, often in combination with biomaterials". [8]
Evidence for benefit of PRP is mixed, with some evidence for use in certain conditions and against use in other conditions. [9] [10] [3] It has been investigated for chronic tendinitis, [11] osteoarthritis, [12] in oral surgery, [13] and in plastic surgery. [14]
A 2022 study from the Journal of Clinical Medicine compared PRP injections to physical therapy. They found that PRP significantly lowered pain scores and increased elbow function. [15] A 2022 study considered PRP for elbow tendinopathy. They found that PRP was effective and that the concentration of the platelets and healing factors such as epidermal growth factor (EGF) were correlated with success of treatment. [16]
A 2022 meta-analysis reviewed 26 studies on PRP for elbow tendinopathy. They found that PRP-treated patients rated their results significantly better using validated patient rated outcomes measures. [17] A 2021 systematic review by the Cochrane Library examined PRP and autologous whole blood injections and concluded that it was "uncertain" if PRP or autologous whole blood injections improved elbow tendon healing. [18]
A 2018 systematic review and meta-analysis of high quality studies found that PRP was beneficial for treatment of lateral epicondylitis. [19]
Numerous reviews and meta-analyses have found that for elbow tendinopathy, PRP is superior to cortisone injections. [20] [21] [22] [23] [24] It has been shown to have similar [25] or equal [26] [27] effects compared to surgery.
A 2022 review and meta-analysis showed improved patient-rated outcomes in patients with partial rotator cuff tears. At 8 weeks post injection, they found PRP to be effective. [28] A 2021 prospective study examined the effectiveness of PRP for partial thickness rotator cuff tears. Patients were given 2 separate PRP injections and followed for 2 years. The study noted: “No adverse events were seen in any patient. Based on global rating scores positive results were seen in 77.9 % of patients at 6 months, 71.6 % at 1 year, and 68.8 % of patients at 2 years”. They found PRP most effective in more damaged tendons. [29] A 2021 meta-analysis found that PRP was effective for partial rotator cuff tears but the effects were no longer evident at 1 year. [30]
PRP has been shown to be superior to cortisone injections in several studies. [31] This is especially evident in the longer term. [32] [33]
A 2019 review found it not to be useful in rotator cuff disease. [3] A 2018 review found that it may be useful. [19] A 2009 review found few randomized controlled trials that adequately evaluated the safety and efficacy of PRP treatments and concluded that PRP was "a promising, but not proven, treatment option for joint, tendon, ligament, and muscle injuries". [34]
Tentative evidence supports the use of PRP in osteoarthritis of the knee. [35] [36] A 2019 meta-analysis found that PRP might be more effective in reducing pain and improving function than hyaluronic acid in knee arthritis. [37]
A 2022 review found insufficient evidence for PRP treatment having a positive effect on meniscus repair and knee function in people with severe knee arthritis. [38]
A 2010 Cochrane review of use in sinus lifts during dental implant placement found no evidence of benefit. [13]
A 2014 Cochrane review of musculoskeletal injuries found very weak evidence for a decrease in pain in the short term, and no difference in function in the short, medium or long term. It has not been shown to be useful for bone healing. [39] A 2016 review of bone graft augmentation found only one study reporting a difference in bone augmentation, while four studies found no difference. [40] As compared to other conservative treatments for non-surgical orthopedic illnesses (e.g. steroid injection for plantar fasciitis), evidence does not support the use of PRP as a conservative treatment. [41] A 2018 review found that evidence was lacking for Achilles tendinopathy. [42] A 2019 meta-analysis found that, for most outcomes in Achilles tendinopathy, PRP treatment did not differ from placebo treatment. [43] A 2019 study conducted an umbrella review that "considered studies that included populations with differing levels of physical activity, including studies on the sporting population (professional and/or recreational athletes) and studies didn't explicitly mention involving a sporting population." This inquiry reported only poor quality evidence that PRP offers any clinical benefits for treatment in acute muscle, tendon, and ligament injuries in any population. [44]
Studies have reported that PRP is beneficial for alopecia areata [45] and androgenetic alopecia and can be used as an alternative to minoxidil or finasteride. [46] A review reported it to improve hair density and thickness in both genders. [47] A minimum of 3 treatments, once a month for 3 months are recommended, and afterwards a 3-6 month period of continual appointments for maintenance. [48] Factors that determine efficacy include number of sessions, double versus single centrifugation, age and gender, and where insertion site. [49]
PRP can be inoculated into the uterine cavity, to improve endometrial receptivity in cases of refractory endometrium. Studies have reported that intrauterine inoculation of PRP before embryo transfer can thicken the endometrium and improve reproductive prognosis. [50] PRP has been studied for the management of Asherman's Syndrome. [51]
PRP can be inoculated experimentally into the ovary to promote ovarian tissue regeneration. The main applications would be in cases of diminished ovarian reserve or premature ovarian failure. [52]
A 2023 retrospective observational study reported PRP's effectiveness in rejuvenating ovarian fertility and viability in terms of "the influence of intraovarian injection of autologous PRP on the levels of E2". [52] and pregnancy outcome in women treated with PRP who had a history of infertility, hormonal abnormalities, an absence of menstrual cycle, and premature ovarian failure in a single centre." [52]
A 2024 review showed that PRP is beneficial when used as intraovarian injections for women with decreased fertility. PRP used for fertility trouble increases AFC, [53] number of cleavage embryos, and improves cancellation rate in women with poor ovarian reserve. However, "Although there was an improvement of baseline hormones (anti-Müllerian hormone, follicle-stimulating hormone, and estradiol) after intraovarian injection of PRP, this improvement failed to reach statistical significance (except the improvement of serum AMH analyzed in quasi-experimental studies)." [54]
Venous ulcers are persistent ankle or lower leg wounds that become open. [55] A 2024 meta-analysis reported a positive effect on the size of ulcers as well as complete healing time for venous ulcers compared to standard treatments. A study combining aPRP with conventional venous ulcer treatments reported improved quality of life and healing time. "In terms of safety, the recurrence rate in the PRP group was significantly lower than that in the control group, while the rates of infection and irritative dermatitis showed no significant difference from the control group." [56]
A 2024 meta-analysis reported that the growth factors present in PRP are vital in the healing of DFU patients; specifically the closure of the ulcers. The author stated that “these treatments significantly increase the ulcer healing rate compared to existing conventional treatments.” [57]
Adverse effects have been reported to be low in most trials. A review reported weak evidence of harm, occurring at comparable, low rates in treated and untreated people. [58] [18]
The three general categories of preparation of PRP based on leukocyte and fibrin content are leukocyte-rich PRP, leukocyte reduced PRP, and leukocyte platelet-rich fibrin. [7] [59]
The efficacy of certain growth factors in healing various injuries and the concentrations of these growth factors found within PRP are the theoretical basis for the use of PRP in tissue repair. [60] Though not required for the process, platelets can be activated by the addition of thrombin or calcium chloride, which induce the release of the factors from alpha granules. The addition of thrombin or calcium chloride is not required as natural thrombin activates the cells upon injection. The growth factors and other cytokines present in PRP include: [60] [61] [62] [63]
PRP is prepared by taking blood from the person, and then putting it through centrifugation designed to separate PRP from platelet-poor plasma and red blood cells. This is usually done in the clinic, using commercially available kits and equipment. [64] The resulting substance varies from person to person and from facility to facility. [64] [65]
PRP has received attention in media [67] [68] [69] as a result of its use by athletes. [70]
In the 2010s, cosmetic procedures marketed under the name of "vampire facials" grew in popularity, fueled by celebrity endorsement. These facials generally center on PRP treatment, and usually involve microneedling. [71] [72]
In April 2024, the CDC announced that three women who had been patients at the Albuquerque, New Mexico, VIP Spa had been diagnosed with HIV after getting such facials. Another almost 200 former clients and their sexual partners tested negative. [73]
PRP has been injected into the vagina, in a procedure called "O-shot [74] " or "orgasm shot", with claims to improve orgasms. [75] No evidence supports such claims. [75] [76]
PRP treatments may violate anti-doping rules. [60] As of 2010, it was not clear whether PRP could have a systemic impact on circulating cytokine levels, affecting doping tests and whether PRP treatments had systemic anabolic effects or affect performance. [60] In January 2011, the World Anti-Doping Agency removed intramuscular injections of PRP from its prohibitions after determining that there is a "lack of any current evidence concerning the use of these methods for purposes of performance enhancement". [77]
In the early 1940s clinicians used extracts of growth factors and cytokines for healing. The term 'platet-rich plasma' was first used in 1954 by Kingsley and in the 1960s the first PRP blood banks were established, becoming popular by the 1970s. [78] In the 1970s PRP was used in hematology, originally for transfusions to treat thrombocytopenia. Ten years later it was used for maxillofacial surgeries. [6] PRP was first used in Italy in 1987 in an open heart surgery procedure. [79] In 2006 PRP was starting to be considered of potential use for both androgenic alopecia and alopecia areata. [6]
Tendinopathy is a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder, elbow, wrist, hip, knee, or ankle.
Osteoarthritis (OA) is a type of degenerative joint disease that results from breakdown of joint cartilage and underlying bone. It is believed to be the fourth leading cause of disability in the world, affecting 1 in 7 adults in the United States alone. The most common symptoms are joint pain and stiffness. Usually the symptoms progress slowly over years. Other symptoms may include joint swelling, decreased range of motion, and, when the back is affected, weakness or numbness of the arms and legs. The most commonly involved joints are the two near the ends of the fingers and the joint at the base of the thumbs, the knee and hip joints, and the joints of the neck and lower back. The symptoms can interfere with work and normal daily activities. Unlike some other types of arthritis, only the joints, not internal organs, are affected.
Tennis elbow, also known as lateral epicondylitis or enthesopathy of the extensor carpi radialis origin, is an enthesopathy of the origin of the extensor carpi radialis brevis on the lateral epicondyle. The outer part of the elbow becomes painful and tender. The pain may also extend into the back of the forearm. Onset of symptoms is generally gradual, although they can seem sudden and be misinterpreted as an injury. Golfer's elbow is a similar condition that affects the inside of the elbow.
Achilles tendinitis, also known as Achilles tendinopathy, occurs when the Achilles tendon, found at the back of the ankle, becomes sore. Achilles tendinopathy is accompanied by alterations in the tendon's structure and mechanical properties. The most common symptoms are pain and swelling around the affected tendon. The pain is typically worse at the start of exercise and decreases thereafter. Stiffness of the ankle may also be present. Onset is generally gradual.
Rotator cuff tendinopathy is a process of senescence. The pathophysiology is mucoid degeneration. Most people develop rotator cuff tendinopathy within their lifetime.
In medicine, a joint injection is a procedure used in the treatment of inflammatory joint conditions, such as rheumatoid arthritis, psoriatic arthritis, gout, tendinitis, bursitis, Carpal Tunnel Syndrome, and occasionally osteoarthritis. A hypodermic needle is injected into the affected joint where it delivers a dose of any one of many anti-inflammatory agents, the most common of which are corticosteroids. Hyaluronic acid, because of its high viscosity, is sometimes used to replace bursa fluids. The technique may be used to also withdraw excess fluid from the joint.
Prolotherapy, also called proliferation therapy, is an injection-based treatment used in chronic musculoskeletal conditions. It has been characterised as an alternative medicine practice.
The management of hair loss, includes prevention and treatment of alopecia, baldness, and hair thinning, and regrowth of hair.
Patellar tendinitis, also known as jumper's knee, is an overuse injury of the tendon that straightens the knee. Symptoms include pain in the front of the knee. Typically the pain and tenderness is at the lower part of the kneecap, though the upper part may also be affected. Generally there is no pain when the person is at rest. Complications may include patellar tendon rupture.
Blood-spinning is a medical procedure used to shorten the healing time of an injury. Small samples of the patient's blood are taken and spun in a centrifuge, allowing platelets and blood serum to be isolated from other blood components. The platelets and plasma are then combined forming platelet-rich plasma (PRP), which has high concentrations of natural growth factors. The PRP sample can then be injected into the patient's injury, which may help reduce pain and improve recovery speeds.
Pattern hair loss is a hair loss condition that primarily affects the top and front of the scalp. In male-pattern hair loss (MPHL), the hair loss typically presents itself as either a receding front hairline, loss of hair on the crown and vertex of the scalp, or a combination of both. Female-pattern hair loss (FPHL) typically presents as a diffuse thinning of the hair across the entire scalp.
Extracorporeal shockwave therapy (ESWT) is a treatment using powerful acoustic pulses which is mostly used to treat kidney stones and in physical therapy and orthopedics.
Autologous blood therapy, also known as autologous blood injection or autohemotherapy, comprises certain types of hemotherapy using a person's own blood. There are several kinds, the original belonging only to traditional medicine, alternative medicine, and some newer kind of medicine under investigation. The original, unscientific form is "the immediate intramuscular or subcutaneous reinjection of freshly drawn autologous blood". It was used in the early 20th century, when some physicians believed that it had efficacy and a logical mechanism of action; it was abandoned as advancing science made clear that it lacked those.
Low-level laser therapy (LLLT), cold laser therapy, photobiomodulation (PBM) or red light therapy is a form of medicine that applies low-level (low-power) lasers or light-emitting diodes (LEDs) to the surface of the body. Whereas high-power lasers are used in laser medicine to cut or destroy tissue, it is claimed that application of low-power lasers relieves pain or stimulates and enhances cell function. The effects appear to be limited to a specified set of wavelengths and new research has demonstrated effectiveness at myopia control. Several such devices are cleared by the United States Food and Drug Administration (FDA), and research shows potential for treating a range of medical problems including rheumatoid arthritis and oral mucositis.
A fibrin scaffold is a network of protein that holds together and supports a variety of living tissues. It is produced naturally by the body after injury, but also can be engineered as a tissue substitute to speed healing. The scaffold consists of naturally occurring biomaterials composed of a cross-linked fibrin network and has a broad use in biomedical applications.
Platelet-Poor Plasma (PPP) is blood plasma with very low number of platelets (< 10 X 103/μL). Traditionally, PPP was recommended for use in platelet aggregation studies to both adjust the platelet-rich plasma concentration, and to serve as a control. PPP may have elevated levels of fibrinogen, which has the ability to form a fibrin-rich clot once activated. Wound healing requires cell migration and attachment, which is facilitated by this fibrin clot.
Collagen induction therapy (CIT), also known as microneedling, dermarolling, or skin needling, is a cosmetic procedure that involves repeatedly puncturing the skin with tiny, sterile needles. CIT should be separated from other contexts in which microneedling devices are used on the skin.
Platelet-rich fibrin (PRF) or leukocyte- and platelet-rich fibrin (L-PRF) is a derivative of PRP where autologous platelets and leukocytes are present in a complex fibrin matrix to accelerate the healing of soft and hard tissue and is used as a tissue-engineering scaffold in oral and maxillofacial surgeries. PRF falls under FDA Product Code KST, labeling it as a blood draw/Hematology product classifying it as 510(k) exempt.
Plasma needling is a minimally invasive aesthetic medical procedure purported to rejuvenate skin, minimize the appearance of hypertrophic and hypotrophic scars and stretchmarks, and reduce pattern hair loss through multimodal physical and biochemical cellular stimulation. It is a combination of classical medical micro-needling by Dermaroller or DermaPen. Both are used in Collagen induction therapy and PRP. The latter is used in Prolotherapy as well as in the Vampire facelift. The effects on fibroblasts, cells, and micro-needling stem cells are published in scientific publications regarding micro-needling, and the injection of PRP, has also been tested as a combined treatment.
James H-C. Wang is a Chinese American orthopedic biomechanist and academic. Currently, he is a Professor at the Departments of Orthopaedic Surgery, Bioengineering, and PM&R at the University of Pittsburgh. In addition, he is a Faculty Member at the McGowan Institute for Regenerative Medicine.
There is presently no information in peer reviewed literature.