Wednesday, December 19, 2007

Platelet Rich Plasma for Colonic Anastomosis

Below is yet another recent study outlining the benefits of PRP in surgery. The data supports the use of platelet rich plasma for further study in colonic anastomosis. Similar data has already been published supporting the use of PRP for achilles tendon repairs. For more PRP information, visit: Apex
J Surg Res. 2007 Oct 26
Effects of Platelet Rich Plasma on Colonic Anastomosis.Tekin A, Yol S, Yilmaz H, Küçükkartallar T, Esen H, Caglayan O.
PURPOSE: To investigate the effect of platelet-rich plasma (PRP) on tissue maturation and wound healing in experimental colonic anastomosis. MATERIALS AND METHODS: Thirty Sprague Dawley rats were divided into three groups of 10 rats each. Group I (control group) was subjected to colon anastomosis only. Group II (PRP group) was subjected to colon anastomosis and topical PRP was applied. Group III (Bioglue group) was subjected to colon anastomosis and topical tissue sealant was applied (Bioglue; Cryolife, Kennesaw, GA). The rats were sacrificed on postoperative day 7, and the bursting pressure of the anastomosis and tissue hydroxyproline levels were measured; histopathological changes on the anastomosis line were also examined. RESULTS: The bursting pressure was statistically higher in the PRP group than in the control and Bioglue groups (P <>

Tuesday, November 20, 2007

The Future of Platelet Rich Plasma

Platelet rich plasma in the last year has taken off as a potential stand alone treatment or a way to augment other treatments. Prospective randomized trials for PRP are on-going in several countries including the US, Sweden, Italy, Spain and the Netherlands. As we continue to gather both basic science and clinical data we will be better able to determine specific applications.

A group of patients and providers has been formed to help work on not just PRP but other potential treatments for tendon injuries and disorders. If you would like to contribute this discussion, please join the Total Tendon Network. To join this group or to learn more, visit: Total


Thursday, November 08, 2007

Platelet Rich Plasma and Growth Hormone

Today the San Francisco Chronicle on the front page of its sports section published an article written by Gwen Knapp on growth hormone use in sports. Dr. Mishra in the article is quoted about the use of platelet rich plasma (PRP). Below is a portion of that article:

Article by Gwen Knapp: "Who’s to say that someday, not far in the future, growth hormone won’t be as common as cortisone? Or that right now, brilliant doctors aren’t chafing under FDA rules and sports world priggishness that prevent them from treating patients at what they believe to be optimal, and safe, levels?"

"I thought Allan Mishra, a surgeon at the Menlo Medical Clinic and an adjunct professor at Stanford, might be one of them. He is researching something called platelet-enriched plasma and its effect on damaged tendons. Platelets are the clotting element in blood, and Mishra said a high concentration of them near a wound appears to trick the body into sending growth factors, a healing agent, to the site."

To read the full article, Click Here

For more PRP information visit: Total

Saturday, October 20, 2007

European Platelet Rich Plasma Achilles Study

There are several trials using Platelet Rich Plasma (PRP) on-going in Europe. Dr. Aspenberg is conducting one in Sweden comparing Achilles tendon repairs with and without PRP. Click here to learn more. Within a year or so, we will have much more robust information about how valueable PRP is for a variety of conditions and injuries.


Wednesday, October 03, 2007

Horse Treated Acutely with Platelet Rich Plasma for Tendon Injury

There is a trend in the horse world to treating acute tendon lesions early with platelet rich plasma with impressive results. See this story below:

For more information about PRP, please visit: Total and/or

Tuesday, October 02, 2007

Video of Platelet Rich Plasma Basic Science


FDA Approves PRP for Wound Healing

Recently, platelet rich plasma in a gel form was approved for treating various types of chronic wounds. It is one of the first specific indications for the use of autologous growth factors in the US. Please see the story below for details.


Sunday, July 29, 2007

Everts Article on Structural Features of PRP

Everts et al (European Surgical Research: 2007) recently published their findings of the structure of platelet rich plasma. Their work is important because it will lead to a better understanding of how and when to use PRP. Further work about exactly how growth factors are released from both platelets and white blood cells is clearly needed. This important paper leads the way.

The picture above is from Evert's fine paper. The top picture is a platelet gel aggregate before the growth factors have been released. The bottom picture clearly shows the empty alpha granules indicating release of growth factors.

For more PRP information, visit:

Wednesday, July 04, 2007

Using Platelet Rich Plasma for a LASIK complication

PRP has been proposed as a treatment for many disorders. Now, we can add post LASIK "Ocular Surface Syndrome" to the list. See the published abstract below for details:

AM from ApexPRP

Treatment of ocular surface syndrome after LASIK with autologous platelet-rich plasma.

PURPOSE: To ascertain the usefulness of platelet-rich plasma in the treatment of patients suffering from symptomatic ocular surface syndrome following LASIK. METHODS: Twenty-six eyes (9 women and 4 men) affected by symptomatic ocular surface syndrome were treated with topical eye drops of autologous platelet-rich plasma and results were reported at 4 weeks. Topical platelet-rich plasma was prepared from total blood and enriched in platelets by centrifugation. RESULTS: Eighty-five percent of patients experienced significant improvement of symptoms; best spectacle-corrected visual acuity increased 1 to 2 lines in 54%; fluorescein staining analysis showed a 69% full fluorescein disappearance; and tear break-up time increased > 2 seconds in 46%. Only one patient developed intolerance to platelet-rich plasma after 4 weeks. CONCLUSIONS: Autologous platelet-rich plasma was effective in the treatment of patients with ocular surface syndrome following LASIK, with symptoms generally relieved and a positive effect on punctate keratitis. Refract Surg. 2007 Jun;23(6):617-9.

Monday, June 25, 2007

PRP and Muscle Tears

Several people have emailed asking about using PRP for muscle injuries. Platelet rich plasma may eventually be a valuable treatment for this type of connective tissue problem. However, to date no significant data has been published or presented to guide physicians or patients. If a patients presents with either an acute or chronic muscle injury PRP may be an option but so far there isn't any specific study to support its use.

This research is rapidly evolving so watch this blog for updates.

Tuesday, June 05, 2007

Platelet Rich Plasma CBS News

Platelet rich plasma and Dr. Allan Mishra's techniques were featured tonight on the CBS evening news. Here is a link to one of the stories:

CBS Evening News Story

For more information about PRP, please visit:

Sunday, June 03, 2007

Achilles Tendon Repair with PRP

Published data supports the use of platelet rich plasma to augment Achilles Tendon repairs. In the picture above, PRP is injected into the sheath around the tendon just prior to skin closure.

Wednesday, May 23, 2007

PRP Improves Wound Healing

Platelet rich plasma in a paper published in the Archives of Facial Plastic Surgery (Hom et al May/June 2007) has been shown to improve closure rates of skin wounds. Specifically, at day 17 after a skin punch wound, 81% of PRP treated wounds were closed versus 57% of controls. The closure velocities were also faster. (p = 0.001).

This is clear evidence that PRP enhances wound healing. In orthopedics and a variety of other specialties, PRP should be strongly considered when doing procedures that have a potentially high wound complication rate such as achilles tendon repair.

The rate of platelet rich plasma publications has also risen dramatically. This indicates more interest in PRP and now more evidence to support its use.

For more information about PRP please visit:

Sunday, May 13, 2007

Platelet Rich Plasma inhibits Macrophages

It is clear that PRP induces increased proliferation in a variety of cell types including fibroblasts and mesenchymal stem cells. This recently published paper discusses how PRP may inhibit macrophage proliferation at least initially. This has broad implications for wound and tissue healing. Further research into these findings should be available soon.

For more PRP information, visit

Cellular effects of platelet rich plasma: a study on HL-60 macrophage-like cells.
Woodall J Jr, Tucci M, Mishra A, Benghuzzi H.
Biomed Sci Instrum. 2007;43:266-71.

Healing injured tissue in the body is a complex process which consists of four distinct phases: hemostasis, inflammation, proliferation, and remodeling. Each of these phases is coordinated by growth factor release and cell to cell interactions. Platelet rich plasma (PRP) is a fraction of plasma that has been isolated and used to enhance regeneration in bone and soft tissues. The healing potential of PRP has been attributed to the release of multiple growth factors from the highly concentrated platelets. While there is strong evidence of the pro-stimulatory effect on the cellular proliferation phase of healing, there is little evidence of the effects of PRP on the inflammatory phase of healing. In this study we investigate the effect that PRP has on macrophage cells in culture and the implications this has on the healing process. We investigate specifically the effects of the separate cellular components of PRP, as a whole and individually, on cell proliferation in human macrophage cells in culture. In contrast to the pro-stimulatory effect that PRP has on cells such as osteoblasts, fibroblasts, and tendon cells; our results show a suppression of macrophages by PRP as early as 24 hours after treatment. This suppression was statistically significant (p=0.002) and continued to be significant for the duration of the study. The cell viability results of PRP compared to platelet poor plasma (PPP) and individual components of PRP showed that PRP resulted in a steady increase in viability following the initial insult to the macrophage cells, while the viability of other treatment groups seemed to plateau.

Monday, May 07, 2007

Platelet Rich Plasma and pH

pH is a measure of the relative acidity of a solution. Physiologic pH is around 7.4. Most commerical PRP preparation machines produce PRP in the zone of 6.9-7.0 in terms of pH. Why is this important? Because the growth factors within PRP work differently at different pHs. Also, the amount of initial pain from an application of acidic PRP is much greater than neutral PRP. Here is a recently published abstract that supports the use of neutral or alkaline PRP. Clearly, more work needs to done in this area. For now, however, converting acidic PRP to neutral PRP appears to have significant value.


Platelets. 2007 Mar;18(2):113-8.
Variation of pH in lysed platelet concentrates influence proliferation and alkaline phosphatase activity in human osteoblast-like cells.
Wahlstrom O, Linder C, Kalen A, Magnusson P.

Faculty of Health Sciences, Division of Orthopaedics, Department of Neuroscience and Locomotion, SE-581 85 Linkoping, Sweden.

Activated platelets release a multifaceted blend of growth factors that has stimulatory effects on mesenchymal cells, both in vitro and in vivo, which imply beneficial effects on wound repair and tissue regeneration. Previous studies on fibroblast cultures have revealed that more potent growth factors, with respect to cell proliferation, are released in acidic preparations of lysed platelet concentrates in comparison with neutral and alkaline preparations. The current study was intended to investigate the influence of pH on lysed platelet concentrates with respect to release of growth factors, cell proliferation and alkaline phosphatase (ALP) activity in human osteoblast-like cells (hFOB 1.19). Cell proliferation was assessed with the MTT kit, ALP activity by conventional enzymatic reaction kinetics and growth factors platelet-derived growth factor (PDGF) and transforming growth factor-beta (TGF-beta) by enzyme-linked immunosorbent assays. Osteoblast-like cells were stimulated with lysed platelet concentrates preincubated at pH 4.4, 5.4, 7.4, and 7.6. A 3-13-fold increase of cell proliferation was found in comparison with controls and the most evident increase was observed with platelets activated at pH 5.4. The highest ALP activity was observed in preparations at pH 7.6. Platelets incubated in an acidic environment (pH 5.4) induced a higher proliferation compared with preincubation at neutral or alkaline pH and the level of PDGF was also found to be higher in acidic preincubations. The level of TGF-beta was, in contrast, lowest at pH 4.4. We suggest, based on these experimental findings, that acidic milieu influence platelets to release growth factors more potent to stimulate osteoblast proliferation than neutral and alkaline platelet preparations. Lysed platelet concentrates prepared at an alkaline pH might release additional components with stimulating effects resulting in other features than cell proliferation. This is the first report, to our knowledge, about a pH dependent stimulatory effect of lysed platelet concentrates on human osteoblast-like cell proliferation. Lysed platelet concentrates, preincubated in acidic or alkaline buffers, may benefit fracture healing, implant fixation and might also be advantageous in the treatment of wounds with platelet constituents; however, this has to be investigated in extended experimental and clinical settings.

Monday, April 30, 2007

Achilles Tendon Tears and Platelet Rich Plasma 2

PRP has been proposed to improve the outcome of achilles tendon repair surgery. Very recently (Sanchez 2007), a study was published that confirmed this hypothesis. If you are having chronic achilles issues or have recently suffered a tear of the tendon, talk to your physician about potentially using platelet rich plasma.

Basic science data also supports its use. As always, review of all treatment options is best done with your treating doctor.

Tuesday, April 24, 2007

Platelet Rich Plasma for Rotator Cuff Tears

The use of PRP in shoulder is just beginning to emerge. Dr. Mishra published positive results in patients with chronic elbow tendonitis (AJSM 2006). The shoulder, however, is much more complex than the elbow. Multiple problems can accompany rotator cuff tendonitis including instability, AC arthritis (the joint between the shoulder and collar bone) and even overlapping pinch nerves in the neck from a disc herniation.

So, determining the value of PRP in shoulders will take more time. Basic science and cell cultures do support its use. Several investigators are evaluating it in patients. We look forward to prospective controlled trials to help us determine value.

Monday, April 16, 2007

Treatment of Iliotibial Band Friction Syndrome with PRP

Several readers have asked about the treatment of IT band friction syndrome with PRP. IT Band tendonitis can developed at the knee or hip and can be quite painful. It is usually associated with running or biking long distances. No large studies have been published using PRP for this problem. The results of surgical intervention for IT Band issues, however, are not always predictable. Therefore, an investigation of the use of PRP for chronic, severe patients with this disorder should be initiated.

Treatment of Dry Eye with PRP

Just when you thought you had heard it all....

Here is a published article that suggests platelet rich plasma may be helpful in the treatment of symptomatic dry eye.

Here is the abstract:

Ophthalmic Res. 2007 Mar 19;39(3):124-129 [Epub ahead of print]

Symptomatic Dry Eye Treatment with Autologous Platelet-Rich Plasma.

Alio JL, Colecha JR, Pastor S, Rodriguez A, Artola A.

Corneal and Refractive Surgery Department, Instituto Oftalmologico de Alicante (Vissum), Alicante, Spain.

Background: Autologous platelet-rich plasma (PRP) has been proven to be very effective on tissue regeneration and wound healing. Here we investigate the potential use of PRP in the treatment of symptomatic dry eye. Methods: Eighteen consecutive patients with symptomatic dry eye were treated with topical PRP and followed up for 1 month. Disappearance of subjective symptoms, increase in best corrected visual acuity, tear meniscus, tear breakup time, decrease in inflammation, fluorescein staining and improvement in impression cytology were measured. Results: Symptoms improved significantly in 89% of the patients, 28% improved at least 1 line of best corrected visual acuity. A significant improvement on lachrymal meniscus and conjunctival hyperemia and a decrease or disappearance of corneal fluorescein staining were observed. Impression cytology revealed a significant increase in conjunctival goblet cells. Conclusion: Treatment of patients suffering from significant dry eye symptoms with autologous RPR proved to be very effective, improving both patient symptoms and major clinical signs.

Antibacterial Effects of Platelet Rich Plasma

In this article published in the British Journal of Bone and Joint Surgery, the anti-bacterial effects of PRP are discussed. There results are most interesting and deserve further investigation.

For more PRP info, visit:

Here is the abstract:

J Bone Joint Surg Br. 2007 Mar;89(3):417-20.

Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances: AN IN VITRO STUDY.

Bielecki TM, Gazdzik TS, Arendt J, Szczepanski T, Krol W, Wielkoszynski T.

1Department and Clinic of Orthopaedics, Medical University of Silesia, Pl. Medykow 1, 41-200, Sosnowiec, Poland.

Platelet-rich plasma is a new inductive therapy which is being increasingly used for the treatment of the complications of bone healing, such as infection and nonunion. The activator for platelet-rich plasma is a mixture of thrombin and calcium chloride which produces a platelet-rich gel. We analysed the antibacterial effect of platelet-rich gel in vitro by using the platelet-rich plasma samples of 20 volunteers. In vitro laboratory susceptibility to platelet-rich gel was determined by the Kirby-Bauer disc-diffusion method. Baseline antimicrobial activity was assessed by measuring the zones of inhibition on agar plates coated with selected bacterial strains. Zones of inhibition produced by platelet-rich gel ranged between 6 mm and 24 mm (mean 9.83 mm) in diameter. Platelet-rich gel inhibited the growth of Staphylococcus aureus and was also active against Escherichia coli. There was no activity against Klebsiella pneumoniae, Enterococcus faecalis, and Pseudomonas aeruginosa. Moreover, platelet-rich gel seemed to induce the in vitro growth of Ps. aeruginosa, suggesting that it may cause an exacerbation of infections with this organism. We believe that a combination of the inductive and antimicrobial properties of platelet-rich gel can improve the treatment of infected delayed healing and nonunion.

Thursday, April 12, 2007

PRP for UCL injuries at the Elbow

The ulnar collateral ligament of the elbow is a major stabilizer that can be injured either acutely or via chronic overuse. Throwers (Pitchers) are especially prone to this type of injuries.

PRP has been proposed as a treatment for strains and partial tears. To date, no one has published or presented their results. It is a treatment to consider but needs more data.

For more PRP info, please visit:

PRP for Posterior Tibial Tendonitis

Several readers have asked about the use of PRP for posterior tibial tendonitis. The posterior tibial tendon is located behind the inside part of the ankle and helps support the arch of the foot. Degeneration or tearing of this tendon can lead to foot and ankle pain.

No one to our knowledge has used PRP for this condition yet. There is increasing evidence that PRP is useful for achilles tendon disorders. Discuss the use of PRP for this condition with your physician and keep watching this blog. We'll post any evidence about the use of PRP for this condition as soon as it becomes available.

For more info about PRP, please visit:

Tuesday, April 10, 2007

Carpal Tunnel Syndrome and Platelet Rich Plasma

Several readers have asked about if PRP can treat Carpal Tunnel. To date, there has been no trial using PRP for this disorder. Carpal tunnel is a form of chronic tendonitis in a tight space that leads to nerve compression. Theoretically, PRP may be able to help. Further research both basic science and clinical trials are needed. Dequervain's Tenosynovitis is another form of chronic wrist tendonitis that has yet to be studied.

Keep checking this blog for the latest research on these important problems.


Tuesday, April 03, 2007

Steroids and Tennis Elbow and Racquet Grip Size

Researchers find that patients treated with steroids do report decreased symptoms initially. However, in most of the patients, their symptoms recur.

"Leanne Bisset, a PhD candidate, and colleagues found that corticosteroid injections provided significantly better results at 6 weeks, but showed subsequently higher recurrence rates (47 of 65 successes regressed) and poorer outcomes in the long term compared with physiotherapy."

From Ortho SuperSite. Click here to read the full article including more details about Platelet Rich Plasma and racquet grip size.

For more PRP information and research:

Sunday, March 25, 2007

Dry Needling vs Platelet Rich Plasma

Dry needling involves simply poking a needle several times into or around a tendon. There is some value to this technique that is supported by literature. The results may be due to bleeding that is caused by the needling. Platelet rich plasma injections are similar to the needling technique but also deliver a concentrated amount of growth factors. In Dr. Mishra's pilot study (AJSM Nov. 2006), PRP proved better than needling for chronic elbow tendinosis. More and larger studies are needed to confirm these results. The exact components of PRP must also be better evaluated. Studies to do just that are on-going. Watch this blog for updates.

Thursday, March 22, 2007

Golfer's Elbow Medial Epicondylitis

Platelet Rich Plasma has been used for chronic golfer's elbow (medial epicondylitis) with success. The number of patients treated is much less than lateral. This procedure is not yet approved in the US but has been done in Europe and elsewhere. The technique is the same as lateral with a local anesthetic injection followed by a injection of 2-3 ml of buffered PRP. Please see Dr. Mishra's paper in the American Journal of Sports Medicine (Nov. 2006) for details.

Monday, February 12, 2007

Platelet Rich Plasma Enhances Mesenchymal Stem Cell Proliferation

This week at the American Academy of Orthopedic Surgery meeting in San Diego, Mishra et al presented data that suggest PRP enhances mesenchymal stem cell proliferation. In their poster, mRNA results showed increased RUNX2, SOX-9 and aggrecan in PRP treated cell cultures versus control. This supports the use of PRP to augment microfracture cartilage restoration surgery. Clearly, further studies are needed but this is an important first step.


Monday, February 05, 2007

Achilles Tendon Tears and Platelet Rich Plasma

Dr. Sanchez from Spain and his co-authors recently published a paper in the American Journal of Sports Medicine (Feb. 2007) that supports the use of platelet rich plasma in achilles tendon repairs. Specifically, he found that PRP treated patients showed no wound complications, took less time to resume running and training activities. the cross-sectional area of the tendons treated with PRP increased less. Overall, they concluded that PRP my present a new way to enhance healing and functional recovery.

This is yet another study that supports the use of PRP for soft tissue musculoskeletal injuries. In my practice I have been using PRP to augment my achilles repairs for years with similar findings. A large prospective trial should be done because of the morbidity that can occur with surgical treatment. It would be interesting to find if the rate of wound complications and/or infection could be reduced with PRP.

AM Apex

Wednesday, January 17, 2007

Platelet Rich Plasma and Tendonitis In-Vitro Evidence

Below is the abstract of a recently published article supporting the use of PRP for tendonitis. This is important work that helps us understand the mechanisms at work within PRP. More of this type of excellent research is needed to further our knowledge of how best to use this emerging biologic tool.


J Orthop Res. 2007 Feb;25(2):230-40. Links
Platelet rich plasma (PRP) enhances anabolic gene expression patterns in flexor digitorum superficialis tendons.

Schnabel LV,
Mohammed HO,
Miller BJ,
McDermott WG,
Jacobson MS,
Santangelo KS,
Fortier LA.
Department of Clinical Sciences, VMC C3-181, Cornell University, Ithaca, New York 14853.

Platelet rich plasma (PRP) has recently been investigated for use in tissue regeneration studies that seek to utilize the numerous growth factors released from platelet alpha-granules. This study examined gene expression patterns, DNA, and collagen content of equine flexor digitorum superficialis tendon (SDFT) explants cultured in media consisting of PRP and other blood products. Blood and bone marrow aspirate (BMA) were collected from horses and processed to obtain plasma, PRP, and platelet poor plasma (PPP). IGF-I, TGF-beta1, and PDGF-BB were quantified in all blood products using ELISA. Tendons were cultured in explant fashion with blood, plasma, PRP, PPP, or BMA at concentrations of 100%, 50%, or 10% in serum-free DMEM with amino acids. Quantitative RT-PCR for expression of collagen type I (COL1A1), collagen type III (COL3A1), cartilage oligomeric matrix protein (COMP), decorin, matrix metalloproteinase-3 (MMP-3), and matrix metalloproteinase-13 (MMP-13) was performed as were DNA and total soluble collagen assays. TGF-beta1 and PDGF-BB concentrations were higher in PRP compared to all other blood products tested. Tendons cultured in 100% PRP showed enhanced gene expression of the matrix molecules COL1A1, COL3A1, and COMP with no concomitant increase in the catabolic molecules MMP-3 and MMP-13. These findings support in vivo investigation of PRP as an autogenous, patient-side treatment for tendonitis. (c) 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:230-240, 2007.

Monday, January 15, 2007

Platelet Rich Plasma Inhibits Demineralized Bone Matrix

In the study outlined below, it is clear that PRP inhibits bone matrix formation. this is consistent with previous reports. Perhaps, PRP is not useful in enchondral ossification but may be helpful in membranous ossification. Further research is needed.


J Bone Joint Surg Am. 2007 Jan;89(1):139-47. Links
Platelet-rich plasma inhibits demineralized bone matrix-induced bone formation in nude mice.Ranly DM, Lohmann CH, Andreacchio D, Boyan BD, Schwartz Z.

It is unclear whether platelet-rich plasma is a clinically effective adjunct to osteoinductive agents such as demineralized bone matrix. It contains platelet-derived growth factor (PDGF), which decreases osteoinduction by human demineralized bone matrix in nude-mouse muscle, suggesting that platelet-rich plasma may also have a negative impact. This study tested the hypothesis that platelet-rich plasma reduces demineralized bone matrix-induced bone formation and that this effect varies with donor-dependent differences in platelet-rich plasma and demineralized bone matrix. Compared with platelet-poor plasma, platelet-rich plasma preparations exhibited a fourfold increase in the platelet count, a fifteenfold increase in the amount of transforming growth factor-beta, a sixfold increase in the amount of PDGF-BB, a fivefold increase in the amount of PDGF-AA, and a twofold increase in the amount of PDGF-AB. Platelet-rich plasma decreased the osteoinductivity of demineralized bone matrix implanted in immunocom-promised mice, and the activities of both demineralized bone matrix and platelet-rich plasma were donor-dependent. CLINICAL RELEVANCE: Platelet-rich plasma may not be an appropriate adjunct to demineralized bone matrix in some clinical applications.

Sunday, January 07, 2007

Platelet Rich Plasma and Meniscus Surgery

Here is the answer to another question about concerning PRP.

There is no data on the use of PRP for meniscus surgery so far. Many years ago, isolated meniscus repair was routinely enhanced using a fibrin clot which is similar to PRP. Again, this type of application makes sense but there isn't any solid information concerning its use in this area yet.

Adding PRP to meniscus repairs is best discussed on an individual basis with your surgeon.


Platelet Rich Plasma and Degenerative Disc Disease

Recently, someone wrote in asking if PRP could help degenerative disc disease. Here is an answer to that question.

Presently, there are no specific human trials using PRP for degenerative disc disease. Theoretical and cell culture evidence does support its use. An article published in the esteemed journal Spine by Akeda et al stated:

"Platelet-rich plasma was effective in stimulating cell proliferation and extracellular matrix metabolism. The response to platelet-rich plasma was greater in the case of anulus fibrosus cells than of nucleus pulposus cells. The local administration of platelet-rich plasma might stimulate intervertebral disc repair. In addition, given the risks of using animal serum for tissue engineering, autologous blood may gain favor as a source of growth factors and serum supplements needed for stimulating cells to engineer intervertebral disc tissues."

Clearly, much more research is needed but the use of PRP for DDD does seem like a reasonable option that may one day be available.

Apex PRP

Saturday, January 06, 2007

Platelet Rich Plasma Enhances Nerve Repair

In the study outlined below, Platelet Rich Plasma improved nerve repair. Specifically, "the data demonstrated a measurable neurotrophic effect when PRP was present, with the most favorable results seen with PRP added to suture".

This is yet another study that helps us understand how to best use PRP.

Allan Mishra APEX PRP


Laryngoscope. 2007 Jan;117(1):157-165.

Effect of Platelet Rich Plasma and Fibrin Sealant on Facial Nerve Regeneration in a Rat Model.

OBJECTIVE:: To investigate the effects of platelet rich plasma (PRP) and fibrin sealant (FS) on facial nerve regeneration. STUDY DESIGN:: Prospective, randomized, and controlled animal study. METHODS:: Experiments involved the transection and repair of facial nerve of 49 male adult rats. Seven groups were created dependant on the method of repair: suture; PRP (with/without suture); platelet poor plasma (PPP) (with/without suture); and FS (with/without suture) groups. Each method of repair was applied immediately after the nerve transection. The outcomes measured were: 1) observation of gross recovery of vibrissae movements within 8-week period after nerve transection and repair using a 5-point scale and comparing the left (test) side with the right (control) side; 2) comparisons of facial nerve motor action potentials (MAP) recorded before and 8 weeks after nerve transection and repair, including both the transected and control (untreated) nerves; 3) histologic evaluation of axons counts and the area of the axons. RESULTS:: Vibrissae movement observation: the inclusion of suturing resulted in overall improved outcomes. This was found for comparisons of the suture group with PRP group; PRP with/without suture groups; and PPP with/without suture groups (P < .05). The PRP without suture group had a significantly greater degree of recovery than the PPP without suture group (P < .05), but it did not have better performance than suture group (P > .05). The movement recovery of the suture group was significantly better than the FS group (P = .014). The recovery of function of the PRP groups was better than that of the FS groups, although this did not reach statistical significance (P = .09). Electrophysiologic testing: there was a significantly better performance of the suture group when compared with the PRP and PPP without suture groups in nerve conduction velocity (P < .05). The PRP with suture group had the best results when compared with the suture as well as the PPP with suture groups in duration and latency-2 of MAP (P < .05). For the FS groups, no results were found demonstrating a biological effect. The PRP with suture group demonstrated the best performance in the latency-2 and the area under the curve of MAP when compared with the suture and FS with suture groups (P < .05). Histomorphometric analysis: PRP with suture demonstrated the greatest increase in axon counts when compared with suture, FS with suture, and PPP with suture groups (P < .05). There was no statistically significant difference seen in axon diameter. CONCLUSION:: The best results for the return of function in our rat facial nerve axotomy models occurred when the nerve ends were sutured together. At the same time, the data demonstrated a measurable neurotrophic effect when PRP was present, with the most favorable results seen with PRP added to suture. There was an improved functional outcome with the use of PRP in comparison with FS or no bioactive agents (PPP). FS showed no benefit over conventional suturing in facial nerve regeneration. Our study provides the potential of a new clinical application for PRP in peripheral nerve regeneration.

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