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Dr Kevin Yip on the Benefits of Platelet Rich Plasma (PRP)

Does science support PRP use in acute soft-tissue injuries?

Although platelet-rich plasma (PRP) has been used for many years in other medical specialties, it has only recently become popular in orthopaedic applications. Media reports of dramatic “cures” in high-profile athletes like Tiger Woods have helped fuel interest in PRP, resulting in a voluminous collection of publications. A recent literature search identified nearly 5,000 articles on PRP, more than a quarter of which were published within the last 5 years.

The use of the body’s own platelets to enhance healing is a seemingly simple concept that promised some very excellent results.

What is it?
PRP is most simply defined as “a volume of plasma that has a platelet count above the baseline of whole blood.” Current PRP preparations, however, can vary markedly in the following ways:

  • the amount of blood used and the efficacy of platelet recovery
  • the presence or absence of white or red blood cells
  • platelet activation with thrombin
  • the level of fibrin production

Some variations in PRP products may result from differing methods of preparation, but even when specific protocols are used, the platelet concentration of the final PRP can vary greatly among techniques and even within a single technique. In addition, platelet concentrations can vary from day to day in PRP produced from a single individual, depending on factors such as diet, general health, medications (eg, coagulants), and exercise.

“The final platelet (growth factor) concentration will be dependent upon the amount of whole blood used, the platelet recovery efficacy, and the final volume of plasma in which the platelets are suspended,” he explained.

The two basic steps in preparing PRP include an initial “soft” spin in a centrifugal separator to divide out plasma and platelets from red and white cells, followed by a “hard” spin that further concentrates the platelets into platelet-rich plasma (PRP) and platelet-poor plasma (PPP) components.

“Patients are seeing elite athletes, like Tiger Woods and Raphael Nadal, being treated with some form of PRP and are asking their orthopaedic surgeons to give them ‘what Tiger got.’

“All three major sports organizations—the National Football League (NFL), Major League Baseball, and the National Basketball Association—as well as the World Anti-Doping Agency, have declared that PRP is a reasonable treatment” .

PRP in soft-tissue injuries
PRP can help with acute Achilles tendon repair, rotator cuff repair, acute ligament injury, muscle injury, and meniscal repair.

A study on the Achilles tendon, for example, found that the operative management of tendons combined with the application of autologous platelet-rich growth factors may present new possibilities for enhanced healing and functional recovery.

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