Skip to main content
Intended for healthcare professionals
Restricted access
Review article
First published online July 1, 2012

The Role of Platelet-Rich Plasma in Inducing Musculoskeletal Tissue Healing

Abstract

Background

Platelet-rich plasma [PRP] has received increasing interest across many musculoskeletal disciplines and has been widely applied clinically to stimulate tissue healing in numerous anatomical regions. The known actions of platelet-derived factors suggest that PRP may have significant potential in the treatment of pathological conditions of cartilage, tendon, ligament, and muscle.

Purpose

The aim of this manuscript is to review current literature regarding the biology of PRP and the efficacy of using PRP to augment healing of tendon ligament and muscle injuries, as well as early osteoarthritis.

Methods

A comprehensive literature review of musculoskeletal applications of PRP was performed, including basic science and clinical studies such as randomized controlled trials, case controlled series, and case series.

Results

The most compelling evidence to support the efficacy of PRP is for its application to tendon damage associated with lateral and medial epicondylitis. Although some promising studies have been reported supporting the use of PRP in osteoarthritis and ligament and muscle injuries, it currently remains unknown whether PRP effectively alters the progression of osteoarthritis or aids the healing of ligament and muscle tissues.

Conclusion

The rationale for the use of PRP to improve tissue healing is strong, but the efficacy for many musculoskeletal applications remains unproven. PRP has been shown to be a safe treatment. A number of questions regarding PRP remain unanswered, including the optimal concentration of platelets, what cell types should be present, the ideal frequency of application, or the optimal rehabilitation regimen for tissue repair and return to full function.

Get full access to this article

View all access and purchase options for this article.

References

1. Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT Autologous platelets as a source of proteins for healing and tissue regeneration Thromb Haemos 200491 4–15
2. Anitua E, Sanchez M, Nurden AT, Zalduendo MM, De la Fuente M, Azofra J, Andia I Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients Rheumatology 200746 1769–1772
3. Arnoczky SP, Caballero O, Yeni YN Platelet-rich Plasma To Augment Connective Tissue Healing: Making Sense of It All J Am Acad Orthop Surg 201018 445–446
4. Barrett S, Erredge S Growth Factors For Chronic Plantar Fasciitis? Podiatry Today 200417 36–42
5. Bogatch MT, Ferachi DG, Kyle B, Popinchalk S, Howell MH, Ge DX, You ZB, Savoie FH Is Chemical Incompatibility Responsible for Chondrocyte Death Induced by Local Anesthetics? Am J Sports Med 201038 520–526
6. Carmona J, Arguelles D, Climent F, Prades M, Soler R, Vidal F, Orozco L Autologous platelet-rich plasma injected intraarticularly diminished synovial effusion and degree of lameness in horses affected with severe joint disease 2005 Lyon Annual Scientific Meeting of the European College of Veterinary Surgeons
7. Castillo TN, Pouliot MA, Kim HJ, Dragoo JL Comparison of Growth Factor and Platelet Concentration From Commercial Platelet-Rich Plasma Separation Systems Am J Sports Med 201039 266–271
8. Castricini R, Longo UG, De Benedetto M, Panfoli N, Pirani P, Zini R, Maffulli N, Denaro V Platelet-Rich Plasma Augmentation for Arthroscopic Rotator Cuff Repair Am J Sports Med 201139 258–265
9. Creaney L, Hamilton B Growth factor delivery methods in the management of sports injuries: the state of play Br J Sports Med 200842 314–320
10. de Mos M, van der Windt AE, Jahr H, van Schie HTM, Weinans H, Verhaar JAN, van Osch G Can platelet-rich plasma enhance tendon repair? A cell culture study Am J Sports Med 200836 1171–1178
11. de Vos RJ, Weir A, Tol JL, Verhaar JAN, Weinans H, van Schie HTM No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy Br J Sports Med 201145 387–392
12. De Vos RJ, Weir A, Van Schie HTM, Bierma-Zeinstra SMA, Verhaar JAN, Weinans H, Tol JL Platelet-rich plasma injection for chronic Achilles tendinopathy: A randomized controlled trial J Am Med Assoc 2010303 144–149
13. Drengk A, Zapf A, Sturmer EK, Sturmer KM, Frosch KH Influence of Platelet-Rich Plasma on Chondrogenic Differentiation and Proliferation of Chondrocytes and Mesenchymal Stem Cells Cells Tissues Organs 2009189 317–326
14. Engebretsen L IOC consensus paper on the use of platelet-rich plasma in sports medicine Br J Sports Med 201044 1072–1081
15. Engert JC, Berglund EB, Rosenthal N Proliferation precedes differentiation in IGF-I-stimulated myogenesis J Cell Biol 1996135 431–440
16. Ferrari M, Zia S, Valbonesi M, Henriquet F, Venere G, Spagnolo S, Grasso MA, Panzani I A new technique for hemodilution, preparation of autologous platelet-rich plasma and intraoperative blood salvage in cardiac-surgery Int J Artificial Organs 198710 47–50
17. Filardo G, Kon E, Della Villa S, Vincentelli F, Fornasari PM, Marcacci M Use of platelet-rich plasma for the treatment of refractory jumper's knee Int Orthop 201034 909–915
18. Fortier LA, Mohammed HO, Lust G, Nixon AJ Insulin-like growth factor-I enhances cell-based repair of articular cartilage J Bone Joint Surg Am 200284 276–288
19. Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA Platelet-rich plasma: From basic science to clinical applications Am J Sports Med 200937 2259–2272
20. Frenkel SR, Saadeh PB, Mehrara BJ, Chin GS, Steinbrech DS, Brent B, Gittes GK, Longker MT Transforming growth factor beta superfamily members: Role in cartilage modeling Plastic Recon Surg 2000105 980–990
21. Gandhi A, Dumas C, O'Connor JP, Parsons JR, Lin SS The effects of local platelet rich plasma delivery on diabetic fracture healing Bone 200638 540–546
22. Gaweda K, Tarczynska M, Krzyzanowski W Treatment of Achilles Tendinopathy with Platelet-Rich Plasma Int J Sports Med 201031 577–583
23. Gosens T, Peerbooms JC, van Laar W, den Oudsten BL Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis Am J Sports Med 201139 1200–1208
24. Grishko V, Xu M, Wilson G, Pearsall AW Apoptosis and Mitochondrial Dysfunction in Human Chondrocytes Following Exposure to Lidocaine, Bupivacaine, and Ropivacaine J Bone Joint Surg Am 201092 609–618
25. Grotendorst GR, Martin GR, Pencev D, Sodek J, Harvey AK Stimulation of granulation-tissue formation by platelet-derived growth-factor in normal and diabetic rats J Clin Invest 198576 2323–2329
26. Hamilton BH, Best TM Platelet-Enriched Plasma and Muscle Strain Injuries: Challenges Imposed by the Burden of Proof Clin J Sports Med 201121 31–36
27. Hammond JW, Hinton RY, Curl LA, Muriel JM, Lovering RM Use of autologous platelet-rich plasma to treat muscle strain injuries Am J Sports Med 200937 1135–1142
28. Harmon KG Muscle injuries and PRP: what does the science say? Brit J Sports Med 201044 616–617
29. Harrison S, Vavken P, Kevy S, Jacobson M, Zurakowski D, Murray MM Platelet activation by collagen provides sustained release of anabolic cytokines Am J Sports Med 201139 729–734
30. Hildebrand KA, Woo SLY, Smith DW, Allen CR, Deie M, Taylor BJ, Schmidt CC The effects of platelet-derived growth factor-BB on healing of the rabbit medial collateral ligament - An in vivo study Am J Sports Med 199826 549–554
31. Joyce ME, Jingushi S, Scully SP, Bolander ME Role of growth factors in fracture healing Progress Clin Biol Res 1991365 391–416
32. Kajikawa Y, Morihara T, Sakamoto H, Matsuda K, Oshima Y, Yoshida A, Nagae M, Arai Y, Kawata M, Kubo T Platelet-rich plasma enhances the initial mobilization of circulation-derived cells for tendon healing J Cell Physiol 2008215 837–845
33. Koerner J, Abdelmessieh P, Azad V, Szczepanowski K, Lin SS, Pinzur M Platelet-Rich Plasma and Its Uses in Foot and Ankle Surgery Techn Foot Ankle Surg 20087 72–78
34. Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions Knee Surg Sports Traumatol Arthrosc 201018 472–479
35. Kon E, Filardo G, Delcogliano M, Presti ML, Russo A, Bondi A, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M Platelet-rich plasma: New clinical application A pilot study for treatment of jumper's knee Injury 200940 598–603
36. Li NL, Hu H, Lindqvist M, Wikstrom-Jonsson E, Goodall AH, Hjemdahl P Platelet-leukocyte cross talk in whole blood Arterioscler Thromb Vasc Biol 200020 2702–2708
37. Li Y, Huard J Differentiation of muscle-derived cells into myofibroblasts in injured skeletal muscle Am J Path 2002161 895–907
38. Majewski M, Ochsner PE, Liu FJ, Fluckiger R, Evans CH Accelerated Healing of the Rat Achilles Tendon in Response to Autologous Conditioned Serum Am J Sports Med 200937 2117–2125
39. Marx RE Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dentistry 200110 225–228
40. McCarrel T, Fortier L Temporal Growth Factor Release from Platelet-Rich Plasma, Trehalose Lyophilized Platelets, and Bone Marrow Aspirate and Their Effect on Tendon and Ligament Gene Expression J Orthop Res 200927 1033–1042
41. Mishra A, Pavelko T Treatment of Chronic Elbow Tendinosis With Buffered Platelet-Rich Plasma Am J Sports Med 200634 1774–1778
42. Nin JRV, Gasque GM, Azcarate AV, Beola JDA, Gonzalez MH Has Platelet-Rich Plasma Any Role in Anterior Cruciate Ligament Allograft Healing? Arthroscopy 200925 1206–1213
43. Obaid H, Connell D Cell Therapy in Tendon Disorders What Is the Current Evidence? Am J Sports Med 201038 2123–2132
44. Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: Platelet-rich plasma versus corticosteroid injection with a 1-year follow-up Am J Sports Med 201038 255–262
45. Pietrzak WS, Eppley BL Platelet rich plasma: Biology and new technology J Craniofacial Surg 200516 1043–1054
46. Randelli PS, Arrigoni P, Cabitza P, Volpi P, Maffulli N Autologous platelet rich plasma for arthroscopic rotator cuff repair. A pilot study Disability Rehab 200830 1584–1589
47. Randelli P, Arrigoni P, Ragone V, Aliprandi A, Cabitza P Platelet Rich Plasma In Arthroscopic Rotator Cuff Repair: A Prospective Rct Study, 2-Year Follow-Up Journal of Shoulder and Elbow Surgery 201020 518–528
48. Ranly DM, McMillan J, Keller T, Lohmann CH, Meunch T, Cochran DL, Schwartz Z, Boyan BD Platelet-derived growth factor inhibits demineralized bone matrix-induced intramuscular cartilage and bone formation - A study of immunocompromised mice J Bone Joint Surg Am 200587 2052–2064
49. Rodeo SA, Delos D, Williams RJ, Adler RA, Pearle A and Warren RF. The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: A prospective randomized clinical study. Under Review, Am J Sports Med, 2011.
50. Sampson S, Reed M, Silvers H, Meng M, Mandelbaum B Injection of Platelet-Rich Plasma in Patients with Primary and Secondary Knee Osteoarthritis A Pilot Study Am J Phys Med Rehab 201089 961–969
51. Sanchez M, Anitua E, Azofra J, Andia I, Padilla S, Mujika I Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices Am J Sports Med 200735 245–251
52. Sanchez M, Anitua E, Azofra J, Prado R, Muruzabal F, Andia I Ligamentization of Tendon Grafts Treated With an Endogenous Preparation Rich in Growth Factors: Gross Morphology and Histology Arthroscopy 201026 470–480
53. Sanchez M, Anitua E, Orive G, Mujika I, Andia I Platelet-Rich Therapies in the Treatment of Orthopaedic Sport Injuries Sports Med 200939 345–354
54. Schepull T, Kvist J, Norrman H, Trinks M, Berlin G, Aspenberg P Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon Ruptures A Randomized Single-Blind Study Am J Sports Med 201139 38–47
55. Schnabel LV, Mohammed HO, Miller BJ, McDermott WG, Jacobson MS, Santangelo KS, Fortier LA Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons J Orthop Res 200725 230–240
56. Sharma P, Maffulli N Current concepts review tendon injury and tendinopathy: Healing and repair J Bone Joint Surg Am 200587 187–202
57. Shen W, Li Y, Tang Y, Cummins J, Huard J NS-398, a cyclooxygenase-2-specific inhibitor, delays skeletal muscle healing by decreasing regeneration and promoting fibrosis Am J Path 2005167 1105–1117
58. Szczodry M, Coyle CH, Kramer SJ, Smolinski P, Chu CR Progressive Chondrocyte Death After Impact Injury Indicates a Need for Chondroprotective Therapy Am J Sports Med 200937 2318–2322
59. Varga-Szabo D, Pleines I, Nieswandt B Cell adhesion mechanisms in platelets Arterioscler Thromb Vasc Biol 200828 403–412
60. Vogrin M, Rupreht M, Dinevski D, Haspl M, Kuhta M, Jevsek M, Knezevic M, Rozman P Effects of a Platelet Gel on Early Graft Revascularization after Anterior Cruciate Ligament Reconstruction: A Prospective, Randomized, Double-Blind, Clinical Trial Europ Surg Res 201045 77–85
61. Wang-Saegusa A, Cugat R, Ares O, Seijas R, Cusco X, Garcia-Balletbo M Infiltration of plasma rich in growth factors for osteoarthritis of the knee short-term effects on function and quality of life Archiv Orthop Traum Surg 2010131 311–317
62. Wright-Carpenter T, Klein P, Schaferhoff P, Appell HJ, Mir LM, Wehling P Treatment of muscle injuries by local administration of autologous conditioned serum: A pilot study on sportsmen with muscle strains Int J Sports Med 200425 588–593
63. Wright-Carpenter T, Opolon P, Appell HJ, Meijer H, Wehling P, Mir LM Treatment of muscle injuries by local administration of autologous conditioned serum: Animal experiments using a muscle contusion model Int J Sports Med 200425 582–587
64. Wurgler-Hauri CC, Dourte LM, Baradet TC, Williams GR, Soslowsky LJ Temporal expression of 8 growth factors in tendon-to-bone healing in a rat supraspinatus model J Shoulder Elb Surgery 200716 198S–203S
65. Zhang JY, Wang JHC Platelet-Rich Plasma Releasate Promotes Differentiation of Tendon Stem Cells Into Active Tenocytes Am J Sports Med 201038 2477–2486
66. Zummstein MA Lesbats V, Trojani C and Boileau P. A New Technique of Biologic Augmentation in Repair of Chroni Rotator Cuff Tears using Autologous Platelet Rich Fibrin (PRF): Vascularization Response and Tendon Healing in a Prospective Randomized Trial. ASES Meeting 2010 Abstracts, p. 27.

Cite article

Cite article

Cite article

OR

Download to reference manager

If you have citation software installed, you can download article citation data to the citation manager of your choice

Share options

Share

Share this article

Share with email
EMAIL ARTICLE LINK
Share on social media

Share access to this article

Sharing links are not relevant where the article is open access and not available if you do not have a subscription.

For more information view the Sage Journals article sharing page.

Information, rights and permissions

Information

Published In

Pages: 137 - 145
Article first published online: July 1, 2012
Issue published: July 2012

Keywords

  1. platelet-rich plasma
  2. ligament
  3. healing
  4. osteoarthritis
  5. tendon

Rights and permissions

© 2012 Hospital for Special Surgery.
Request permissions for this article.
PubMed: 23874254

Authors

Affiliations

Brian C. Halpern, MD
Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA
Salma Chaudhury, MD, PhD
Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA
Scott A. Rodeo, MD
Hospital for Special Surgery, 535 East 70th Street, 10021, New York, NY, USA

Notes

Metrics and citations

Metrics

Journals metrics

This article was published in HSS Journal®: The Musculoskeletal Journal of Hospital for Special Surgery.

VIEW ALL JOURNAL METRICS

Article usage*

Total views and downloads: 94

*Article usage tracking started in December 2016


Articles citing this one

Receive email alerts when this article is cited

Web of Science: 0

Crossref: 51

  1. Fucoidan-coated cotton dressing functionalized with biomolecules cappe...
    Go to citation Crossref Google Scholar
  2. Recent Nonoperative Treatment of Elbow Pain
    Go to citation Crossref Google Scholar
  3. Role of platelet-rich plasma in the treatment of rotator cuff tendinop...
    Go to citation Crossref Google Scholar
  4. Platelet-Rich Plasma for Knee Osteoarthritis: What Does the Evidence S...
    Go to citation Crossref Google Scholar
  5. Regenerative medicine and orthobiological drugs possibilities in upper...
    Go to citation Crossref Google Scholar
  6. Influence of platelet-rich plasma (PRP) analogues on healing and clini...
    Go to citation Crossref Google Scholar
  7. Orthobiologic Treatment of Ligament Injuries
    Go to citation Crossref Google Scholar
  8. Platelet-rich Plasma in Patients with Symptomatic Osteoarthritis Knee:...
    Go to citation Crossref Google Scholar
  9. Rehabilitation and Return to Sport Following Elbow Injuries
    Go to citation Crossref Google Scholar
  10. A bilineage thermosensitive hydrogel system for stimulation of mesench...
    Go to citation Crossref Google Scholar
  11. Medial Elbow Disorders
    Go to citation Crossref Google Scholar
  12. Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose c...
    Go to citation Crossref Google Scholar
  13. Clinical Outcomes of Meniscus Repair with or without Multiple Intra-Ar...
    Go to citation Crossref Google Scholar
  14. Evidence-based indications of platelet-rich plasma therapy
    Go to citation Crossref Google Scholar
  15. Tratamiento ortobiológico con plasma rico en plaquetas. Revisión siste...
    Go to citation Crossref Google Scholar
  16. Cytokine and Growth Factor Delivery from Implanted Platelet-Rich Fibri...
    Go to citation Crossref Google Scholar
  17. Platelet-Rich Products and Their Application to Osteoarthritis
    Go to citation Crossref Google Scholar
  18. Lateral Epicondylitis
    Go to citation Crossref Google Scholar
  19. Medial Epicondylitis
    Go to citation Crossref Google Scholar
  20. Infiltración ecoguiada articular de plasma rico en factores de crecimi...
    Go to citation Crossref Google Scholar
  21. Comparison of the protocols for obtaining platelet-rich plasma in dogs...
    Go to citation Crossref Google Scholar
  22. Role of Mechanical Loading for Platelet-Rich Plasma-Treated Achilles T...
    Go to citation Crossref Google Scholar
  23. Rehabilitation of hamstring strains: does a single injection of platel...
    Go to citation Crossref Google Scholar
  24. Current advances in the treatment of medial and lateral epicondylitis
    Go to citation Crossref Google Scholar
  25. Platelet-Rich Plasma (PRP): Procedural Techniques for Musculoskeletal ...
    Go to citation Crossref Google Scholar
  26. Platelet-Rich Plasma Therapy: An Overview
    Go to citation Crossref Google Scholar
  27. Medial
    Go to citation Crossref Google Scholar
  28. Comparative Analysis of Different Platelet Lysates and Platelet Rich P...
    Go to citation Crossref Google Scholar
  29. Superparamagnetic Iron Oxide Nanoparticles in Musculoskeletal Biology
    Go to citation Crossref Google Scholar
  30. Normal platelet function in platelet concentrates requires non-platele...
    Go to citation Crossref Google Scholar
  31. Ultrasound biomicroscopy and claudication test for in vivo follow-up o...
    Go to citation Crossref Google Scholar
  32. Medial Epicondylitis
    Go to citation Crossref Google Scholar
  33. Platelet-rich plasma for chronic lateral epicondylitis: Is one injecti...
    Go to citation Crossref Google Scholar
  34. Platelet-rich plasma in orthopedic therapy: a comparative systematic r...
    Go to citation Crossref Google Scholar
  35. Thromboelastographic Clot Characteristics of Autologous Equine Blood P...
    Go to citation Crossref Google Scholar
  36. Platelet-rich plasma for muscle injuries: game over or time out?
    Go to citation Crossref Google Scholar
  37. Synthesis, development, characterization and effectiveness of bovine p...
    Go to citation Crossref Google Scholar
  38. Platelet-rich plasma and other cellular strategies in orthopedic surge...
    Go to citation Crossref Google Scholar
  39. Site-Specific Targeting of Platelet-Rich Plasma via Superparamagnetic ...
    Go to citation Crossref Google ScholarPub Med
  40. New and Emerging Strategies in Platelet-Rich Plasma Application in Mus...
    Go to citation Crossref Google Scholar
  41. Lateral Epicondylosis
    Go to citation Crossref Google Scholar
  42. Platelet-Rich Plasma: From Laboratory to the Clinic
    Go to citation Crossref Google Scholar
  43. Role of Embedded Pure Xenogenous Bovine Platelet Gel on Experimental T...
    Go to citation Crossref Google Scholar
  44. Synergistic anabolic actions of hyaluronic acid and platelet-rich plas...
    Go to citation Crossref Google Scholar
  45. Traitement par PRP, mise au point (septembre 2014). Première partie : ...
    Go to citation Crossref Google Scholar
  46. Variance of matrix metalloproteinase (MMP) and tissue inhibitor of met...
    Go to citation Crossref Google Scholar
  47. Magnetic Resonance Imaging of Cartilage Repair Procedures
    Go to citation Crossref Google Scholar
  48. Epicondylitis
    Go to citation Crossref Google Scholar
  49. Traitement par PRP 1e partie : les lésions cartilagineuses et musculai...
    Go to citation Crossref Google Scholar
  50. Platelet-Rich Plasma: From Laboratory to the Clinic
    Go to citation Crossref Google Scholar
  51. Adipose-Derived Stem Cells: Methods for Isolation and Applications for...
    Go to citation Crossref Google Scholar

Figures and tables

Figures & Media

Tables

View Options

Get access

Access options

If you have access to journal content via a personal subscription, university, library, employer or society, select from the options below:

HSS Sponsored Access


HSS sponsors access for many subscribers. Sponsored subscribers must activate their accounts to access the journal. Please read the instructions on activating your account for help.

HSS Sponsored Access


HSS sponsors access for many subscribers. Sponsored subscribers must activate their accounts to access the journal. Please read the instructions on activating your account for help.


Alternatively, view purchase options below:

Access journal content via a DeepDyve subscription or find out more about this option.

View options

PDF/ePub

View PDF/ePub

Full Text

View Full Text