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Kon E, Anzillotti G, Conte P, Ruosi L, Cole B, Dragoo J, Zaslav K, Frank R, De Girolamo L, Mandelbaum B, Rodeo S, Marcacci M, Filardo G, Di Matteo B. The chimera of reaching a universal consensus on platelet-rich plasma treatment for knee osteoarthritis: a review of recent consensus statements and expert opinion. Expert Opin Biol Ther 2024:1-7. [PMID: 39073848 DOI: 10.1080/14712598.2024.2383865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 06/28/2024] [Accepted: 07/20/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Osteoarthritis (OA) is a prevalent cause of disability worldwide, affecting millions and posing significant socioeconomic burdens. Various conservative measures like hyaluronic acid (HA) and platelet-rich plasma (PRP) injections aim to manage OA symptoms and delay surgical interventions. Despite the increasing utilization of PRP, consensus on its efficacy remains elusive, reflecting the evolving landscape of OA management. AREAS COVERED This study reviews guidelines and recommendations on intra-articular PRP injections for OA globally, highlighting divergent perspectives among different medical societies. A comprehensive literature search identified 19 relevant guidelines, indicating a temporal and geographic evolution in attitudes toward PRP use. While some guidelines endorse PRP for mild-to-moderate OA, others express caution due to concerns about product standardization and clinical evidence heterogeneity. EXPERT OPINION The lack of universal consensus on PRP for OA underscores the complex interplay between clinical evidence, practice patterns, and evolving perspectives. Recent shifts toward endorsing PRP may reflect advancements in preparation techniques and personalized medicine approaches. However, challenges persist, including patient selection and product standardization. Efforts to develop consensus and refine PRP classification systems are essential for guiding clinical practice and advancing OA management.
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Affiliation(s)
- Elizaveta Kon
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giuseppe Anzillotti
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Pietro Conte
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Luca Ruosi
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Brian Cole
- Midwest Orthopaedics at Rush University Medical Center, Chicago, IL, USA
| | - Jason Dragoo
- Division of Sports Medicine, Department of Orthopaedic Surgery, School of Medicine, University of Colorado, Boulder, CO, USA
| | - Ken Zaslav
- Center for Regenerative Orthopedic Medicine, Northwell Health-Lenox Hill Hospital, New York, NY, USA
- Orthopedic Surgery Zucker School of Medicine Hofstra University, New York, NY, USA
| | - Rachel Frank
- Department of Orthopaedic Surgery, University of Colorado School of Medicine, Denver, CO, USA
| | | | | | - Scott Rodeo
- Orthopedic Soft Tissue Research Program, Hospital for Special Surgery, New York, NY, USA
- Department of Medicine Weill Cornell Medicine, New York, NY, USA
| | - Maurilio Marcacci
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giuseppe Filardo
- Department of Surgery, Service of Orthopaedics and Traumatology, Lugano, EOC, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
- Applied and Translational Research (ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Berardo Di Matteo
- IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
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Muthu S, Krishnan A, Ramanathan KR. Standardization and validation of a conventional high yield platelet-rich plasma preparation protocol. Ann Med Surg (Lond) 2022; 82:104593. [PMID: 36268335 PMCID: PMC9577528 DOI: 10.1016/j.amsu.2022.104593] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/30/2022] [Accepted: 09/04/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Of late, numerous randomised controlled trials report platelet-rich plasma (PRP) to be ineffective with preparation protocols of low platelet yield despite using expensive commercial PRP kits. OBJECTIVE This study aims to identify and standardize a preparation protocol for PRP with maximum platelets yield and concentration to obtain favourable results without the use of commercial preparation kits. MATERIALS & METHODS Blood samples were collected from 40 healthy volunteers who signed informed consent for participation in the study. The double spin protocol of PRP preparation was analyzed for variables such as centrifugal acceleration, time, and volume of blood processed and final product utilized. The final PRP prepared was investigated for platelet recovery, concentration, integrity, and viability. Each protocol investigated with technical and biological duplicates to avoid reporting and sampling bias. RESULTS We noted maximum platelet recovery (86-99%) with a consistent 6.4 ± 0.8 times the baseline concentration of platelets with first centrifugation at 100g for 15 min followed by second centrifugation at 1600g for 20 min. We did not note a loss of integrity or viability of the platelets in the final product from the above-said protocol. We also validated the protocol among all the study participants demonstrating consistency. CONCLUSION The preparation of PRP by the double-spin protocol using 10 ml of blood at 100 g followed by 1600 g for 15 and 20 min respectively in a 15 ml tube and using the lower 1/3rd of the final product demonstrated consistent high platelet recovery (86-99%) and concentration (6x) without disturbing the platelet integrity or viability.
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Affiliation(s)
- Sathish Muthu
- Department of Orthopaedics, Government Medical College, Dindigul, Tamil Nadu, India
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Biotechnology, School of Engineering and Technology, Sharda University, New Delhi, India
- Corresponding author. Department of Orthopaedics, Government Medical College, Dindigul, Tamil Nadu, India.
| | - Anand Krishnan
- Orthopaedic Research Group, Coimbatore, Tamil Nadu, India
- Department of Chemical Pathology, School of Pathology, Faculty of Health Sciences, University of the Free State, Bloemfontein, 9300, South Africa
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Moeda F, Melo X, Hatia M, Pinho S, Calado D, Branco JC, Gonçalves MJ. The Effects of Intra-Articular Platelet-Rich Plasma Injections in Rheumatoid Arthritis: A Narrative Review. Cureus 2022; 14:e28182. [PMID: 36148189 PMCID: PMC9482810 DOI: 10.7759/cureus.28182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2022] [Indexed: 11/17/2022] Open
Abstract
Platelet-rich plasma injections have been a therapeutic option with exponential growth in several pathologies in the last decades, particularly musculoskeletal for their effect on improving pain and functionality. Rheumatoid arthritis is a chronic joint disease, which involves inflammation of the synovial membrane with cartilage and juxta-articular bone destruction. Conventional and biological disease-modifying anti-rheumatoid drugs are the cornerstone of the treatment of this disease. However, the use of intra-articular glucocorticoids is often necessary and the role of platelet-rich plasma injections in these patients remains uncertain. A literature review was carried out through the PubMed database, Cochrane and Google Scholar for the search terms “rheumatoid arthritis” and “platelet-rich plasma”. Eleven studies have been included in this review: two of these are in vitro studies, five are animal studies, one case report, two case series and one randomized controlled trial. Most of the studies demonstrated a decrease in pain and inflammatory mediators and improvement of functional outcomes, with no severe adverse effects reported. However, the quantity and quality of literature about the effects and safety of plasma-rich plasma injections in rheumatoid arthritis patients are still scarce. It is essential that well-designed randomized controlled trials are made on this topic to understand if platelet-rich plasma may be useful as a coadjuvant therapy in rheumatoid arthritis.
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Leukocyte-Rich Platelet-Rich Plasma as an Effective Source of Molecules That Modulate Local Immune and Inflammatory Cell Responses. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2022; 2022:8059622. [PMID: 35958021 PMCID: PMC9363181 DOI: 10.1155/2022/8059622] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/18/2022] [Indexed: 11/17/2022]
Abstract
Autologous platelet-rich plasma (PRP) injection is a safe biological method used to treat various musculoskeletal diseases. By downregulation of inflammatory cytokines and stimulation of synovial fibroblasts, PRP injection is a promising adjunctive treatment for patients with chronic autoimmune inflammatory diseases such as rheumatoid arthritis. A major problem in comparing the results of clinical trials in this area is the considerable variability in the cytokine content of PRP. We presented the profile of selected growth factors and inflammatory cytokines in the obtained PRP samples and compared them with baseline serum levels to assess the efficacy of PRP as a source of those paracrine molecules. Additionally, we wanted to determine whether the difference is only quantitative, which would suggest the use of a cheaper alternative by injecting a large amount of autologous serum. For this purpose, we analyzed whole blood and PRP samples prepared using the Mini GPS III Platelet Concentration System (Biomet Inc., USA) in 31 subjects aged 35-60 years. Cellular content, seven selected growth factors, and 13 human inflammatory cytokines were evaluated. Multiplex bead immunoassays that use fluorescence-encoded beads LEGENDplex™ (BioLegend, USA) and flow cytometer measurements were used. As a result, we found a statistically significant increase in four of the growth factors tested and eight of the inflammatory cytokines tested in PRP compared to blood serum. The difference is not only quantitative but also in the composition of paracrine molecules. In conclusion, the study confirmed that PRP is an efficient source of several growth factors and some inflammatory cytokines. These data provide additional insight into the potential mechanisms of PRP’s effects on cellular metabolism and inflammatory response and may contribute to a better understanding of its clinical efficacy.
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