Semin Musculoskelet Radiol 2013; 17(01): 091-098
DOI: 10.1055/s-0033-1333943
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Platelet-Rich Plasma Injection

Kenneth S. Lee
1   Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
› Author Affiliations
Further Information

Publication History

Publication Date:
13 March 2013 (online)

Abstract

Platelet-rich plasma injection is an emerging alternative treatment method for common musculoskeletal tendon injuries. This article discusses the biology of platelet-rich plasma, explains how it may promote healing, highlights some common applications of platelet-rich plasma and reviews the current clinical evidence-based literature.

 
  • References

  • 1 Housner JA, Jacobson JA, Misko R. Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med 2009; 28 (9) 1187-1192
  • 2 McShane JM, Nazarian LN, Harwood MI. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. J Ultrasound Med 2006; 25 (10) 1281-1289
  • 3 Rabago D, Best TM, Zgierska AE, Zeisig E, Ryan M, Crane D. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma. Br J Sports Med 2009; 43 (7) 471-481
  • 4 Park EJ, Kim ES, Weber HP, Wright RF, Mooney DJ. Improved bone healing by angiogenic factor-enriched platelet-rich plasma and its synergistic enhancement by bone morphogenetic protein-2. Int J Oral Maxillofac Implants 2008; 23 (5) 818-826
  • 5 Schwarz A. A promising treatment for athletes, in blood. New York Times, February 17, 2009
  • 6 Foster TE, Puskas BL, Mandelbaum BR, Gerhardt MB, Rodeo SA. Platelet-rich plasma: from basic science to clinical applications. Am J Sports Med 2009; 37 (11) 2259-2272
  • 7 Wroblewski APMH, Wright VJ. Application of platelet-rich plasma to enhance tissue repair. Oper Tech Orthop 2010; 20: 98-105
  • 8 Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1998; 85 (6) 638-646
  • 9 Marx R. Platelet-function—assays and events: introduction. Suppl Thromb Haemost 1978; 63: 65-80
  • 10 de Mos M, van der Windt AE, Jahr H , et al. Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med 2008; 36 (6) 1171-1178
  • 11 Lyras DN, Kazakos K, Agrogiannis G , et al. Experimental study of tendon healing early phase: is IGF-1 expression influenced by platelet rich plasma gel?. Orthop Traumatol Surg Res 2010; 96 (4) 381-387
  • 12 Everts PA, Knape JT, Weibrich G , et al. Platelet-rich plasma and platelet gel: a review. J Extra Corpor Technol 2006; 38 (2) 174-187
  • 13 Lyras DN, Kazakos K, Verettas D , et al. The influence of platelet-rich plasma on angiogenesis during the early phase of tendon healing. Foot Ankle Int 2009; 30 (11) 1101-1106
  • 14 Schnabel LV, Mohammed HO, Miller BJ , et al. Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons. J Orthop Res 2007; 25 (2) 230-240
  • 15 Smith SE, Roukis TS. Bone and wound healing augmentation with platelet-rich plasma. Clin Podiatr Med Surg 2009; 26 (4) 559-588
  • 16 Dohan Ehrenfest DM, Rasmusson L, Albrektsson T. Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF). Trends Biotechnol 2009; 27 (3) 158-167
  • 17 Cieslik-Bielecka A, Bielecki T, Gazdzik TS, Arendt J, Król W, Szczepanski T. Autologous platelets and leukocytes can improve healing of infected high-energy soft tissue injury. Transfus Apheresis Sci 2009; 41 (1) 9-12
  • 18 Griffin XL, Smith CM, Costa ML. The clinical use of platelet-rich plasma in the promotion of bone healing: a systematic review. Injury 2009; 40 (2) 158-162
  • 19 Alsousou J, Thompson M, Hulley P, Noble A, Willett K. The biology of platelet-rich plasma and its application in trauma and orthopaedic surgery: a review of the literature. J Bone Joint Surg Br 2009; 91 (8) 987-996
  • 20 Jeong GK, Sandhu HS, Farmer J. Bone morphogenic proteins: applications in spinal surgery. HSS J 2005; 1 (1) 110-117
  • 21 Field LD, Savoie FH. Common elbow injuries in sport. Sports Med 1998; 26 (3) 193-205
  • 22 Tuite MJ, Kijowski R. Sports-related injuries of the elbow: an approach to MRI interpretation. Clin Sports Med 2006; 25 (3) 387-408, v
  • 23 Zeisig E, Ohberg L, Alfredson H. Extensor origin vascularity related to pain in patients with tennis elbow. Knee Surg Sports Traumatol Arthrosc 2006; 14 (7) 659-663
  • 24 Zeisig E, Fahlström M, Ohberg L, Alfredson H. A two-year sonographic follow-up after intratendinous injection therapy in patients with tennis elbow. Br J Sports Med 2010; 44 (8) 584-587
  • 25 Kijowski R, De Smet AA. The role of ultrasound in the evaluation of sports medicine injuries of the upper extremity. Clin Sports Med 2006; 25 (3) 569-590, viii
  • 26 Levin D, Nazarian LN, Miller TT , et al. Lateral epicondylitis of the elbow: US findings. Radiology 2005; 237 (1) 230-234
  • 27 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 2010; 38 (2) 255-262
  • 28 Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: a double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med 2011; 39 (6) 1200-1208
  • 29 Goel DP, Chan D, Watson K, Mohtadi N. Safety and hospital costs of Achilles tendon surgery: the serendipitous impact of a randomized clinical trial. Can J Surg 2009; 52 (6) 467-472
  • 30 Paavola M, Kannus P, Järvinen TA, Khan K, Józsa L, Järvinen M. Achilles tendinopathy. J Bone Joint Surg Am 2002; 84-A (11) 2062-2076
  • 31 de Vos RJ, Weir A, van Schie HT , et al. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 2010; 303 (2) 144-149
  • 32 de Jonge S, de Vos RJ, Weir A , et al. One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: a double-blind randomized placebo-controlled trial. Am J Sports Med 2011; 39 (8) 1623-1629
  • 33 Rabago D, Wilson J, Zgierska A.. Platelet-rich plasma for treatment of Achilles tendinopathy. JAMA 2010; 303 (17) 1696-1697 ; author reply 1697–1698
  • 34 Kubo K, Yajima H, Takayama M, Ikebukuro T, Mizoguchi H, Takakura N. Effects of acupuncture and heating on blood volume and oxygen saturation of human Achilles tendon in vivo. Eur J Appl Physiol 2010; 109 (3) 545-550
  • 35 Glazer JL. An approach to the diagnosis and treatment of plantar fasciitis. Phys Sportsmed 2009; 37 (2) 74-79
  • 36 Jeswani T, Morlese J, McNally EG. Getting to the heel of the problem: plantar fascia lesions. Clin Radiol 2009; 64 (9) 931-939
  • 37 McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel pain—plantar fasciitis: clinical practice guidelines linked to the international classification of function, disability, and health from the orthopaedic section of the American Physical Therapy Association. J Orthop Sports Phys Ther 2008; 38 (4) A1-A18
  • 38 Neufeld SK, Cerrato R. Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg 2008; 16 (6) 338-346
  • 39 Digiovanni BF, Nawoczenski DA, Malay DP , et al. Plantar fascia-specific stretching exercise improves outcomes in patients with chronic plantar fasciitis. A prospective clinical trial with two-year follow-up. J Bone Joint Surg Am 2006; 88 (8) 1775-1781
  • 40 Donley BG, Moore T, Sferra J, Gozdanovic J, Smith R. The efficacy of oral nonsteroidal anti-inflammatory medication (NSAID) in the treatment of plantar fasciitis: a randomized, prospective, placebo-controlled study. Foot Ankle Int 2007; 28 (1) 20-23
  • 41 Hyland MR, Webber-Gaffney A, Cohen L, Lichtman PT. Randomized controlled trial of calcaneal taping, sham taping, and plantar fascia stretching for the short-term management of plantar heel pain. J Orthop Sports Phys Ther 2006; 36 (6) 364-371
  • 42 Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc 2003; 93 (3) 234-237
  • 43 Zanetti M, Metzdorf A, Kundert HP , et al. Achilles tendons: clinical relevance of neovascularization diagnosed with power Doppler US. Radiology 2003; 227 (2) 556-560
  • 44 Hartgerink P, Fessell DP, Jacobson JA, van Holsbeeck MT. Full- versus partial-thickness Achilles tendon tears: sonographic accuracy and characterization in 26 cases with surgical correlation. Radiology 2001; 220 (2) 406-412
  • 45 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 Int Orthop 2010; 34 (6) 909-915
  • 46 Kalaci A, Cakici H, Hapa O, Yanat AN, Dogramaci Y, Sevinç TT. Treatment of plantar fasciitis using four different local injection modalities: a randomized prospective clinical trial. J Am Podiatr Med Assoc 2009; 99 (2) 108-113
  • 47 Barrett SES. Growth factors for chronic plantar fasciitis. Podiatry Today 2004; 17: 37-42
  • 48 Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 2006; 34 (11) 1774-1778
  • 49 Kjaer M. Role of extracellular matrix in adaptation of tendon and skeletal muscle to mechanical loading. Physiol Rev 2004; 84 (2) 649-698
  • 50 Gottlieb NL, Riskin WG. Complications of local corticosteroid injections. JAMA 1980; 243 (15) 1547-1548
  • 51 Alfredson H, Lorentzon R. Chronic Achilles tendinosis: recommendations for treatment and prevention. Sports Med 2000; 29 (2) 135-146
  • 52 Malliaropoulos N, Papacostas E, Kiritsi O, Papalada A, Gougoulias N, Maffulli N. Posterior thigh muscle injuries in elite track and field athletes. Am J Sports Med 2010; 38 (9) 1813-1819
  • 53 Orchard J, Best TM. The management of muscle strain injuries: an early return versus the risk of recurrence. Clin J Sport Med 2002; 12 (1) 3-5
  • 54 Armfield DR, Kim DH, Towers JD, Bradley JP, Robertson DD. Sports-related muscle injury in the lower extremity. Clin Sports Med 2006; 25 (4) 803-842
  • 55 CPT Category III codes. American Medical Association Web site. Available at: http://www.ama-assn.org/ama1/pub/upload/mm/362/cptcat3codes.pdf