Platelet‐rich plasma: why intra‐articular? A systematic review of preclinical studies and clinical evidence on PRP for joint degeneration

Abstract

Purpose The aim of this review was to analyze the available evidence on the clinical application of this biological approach for the injective treatment of cartilage lesions and joint degeneration, together with preclinical studies to support the rationale for the use of platelet concentrates, to shed some light and give indications on what to treat and what to expect from intra‐articular injections of platelet‐rich plasma (PRP). Methods All in vitro, in vivo preclinical and clinical studies on PRP injective treatment in the English language concerning the effect of PRP on cartilage, synovial tissue, menisci, and mesenchymal stem cells were considered. A systematic review on the PubMed database was performed using the following words: (platelet‐rich plasma or PRP or platelet concentrate or platelet lysate or platelet supernatant) and (cartilage or chondrocytes or synoviocytes or menisci or mesenchymal stem cells). Results Fifty‐nine articles met the inclusion criteria: 26 were in vitro, 9 were in vivo, 2 were both in vivo and in vitro, and 22 were clinical studies. The analysis showed an increasing number of published studies over time. Preclinical evidence supports the use of PRP injections that might promote a favourable environment for joint tissues healing. Only a few high‐quality clinical trials have been published, which showed a clinical improvement limited over time and mainly documented in younger patients not affected by advanced knee degeneration. Conclusions Besides the limits and sometimes controversial findings, the preclinical literature shows an overall support toward this PRP application. An intra‐articular injection does not just target cartilage; instead, PRP might influence the entire joint environment, leading to a short‐term clinical improvement. Many biological variables might influence the clinical outcome and have to be studied to optimize PRP injective treatment of cartilage degeneration and osteoarthritis. Level of evidence IV.

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References 78

1. 1.

   Akeda K, An HS, Okuma M, Attawia M, Miyamoto K, Thonar EJ, Lenz ME, Sah RL, Masuda K. Platelet-rich plasma stimulates porcine articular chondrocyte proliferation and matrix biosynthesis. Osteoarthritis Cartil. 2006;14(12):1272-1280.

   Not in our library10.1016/j.joca.2006.05.008

2. 2.

   Anitua E, Sánchez M, Nurden AT, Zalduendo MM, de la Fuente M, Azofra J, Andía I. Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology (Oxford). 2007;46(12):1769-1772.

   Not in our library10.1093/rheumatology/kem234

3. 3.

   Anitua E, Sánchez M, Orive G (2010) Potential of endogenous regenerative technology for in situ regenerative medicine. Adv Drug Deliv Rev 15;62(7–8):741–752

   Not in our library10.1016/j.addr.2010.01.001

4. 4.

   Battaglia M, Guaraldi F, Vannini F, Buscio T, Buda R, Galletti S, Giannini S. Platelet-rich plasma (PRP) intra-articular ultrasound-guided injections as a possible treatment for hip osteoarthritis: a pilot study. Clin Exp Rheumatol. 2011;29(4):754.

   Not in our library

5. 5.

   Bendinelli P, Matteucci E, Dogliotti G, Corsi MM, Banfi G, Maroni P, Desiderio MA. Molecular basis of anti-inflammatory action of platelet-rich plasma on human chondrocytes: mechanisms of NF-κB inhibition via HGF. J Cell Physiol. 2010;225(3):757-766.

   Not in our library10.1002/jcp.22274

6. 6.

   Browning SR, Weiser AM, Woolf N, Golish SR, SanGiovanni TP, Scuderi GJ, Carballo C, Hanna LS. Platelet-rich plasma increases matrix metalloproteinases in cultures of human synovial fibroblasts. J Bone Joint Surg Am. 2012;94(23):e1721-e1727.

   Not in our library10.2106/jbjs.k.01501

7. 7.

   Carmona JU, Arguelles D, Climent F, Prades M (2007) Autologous platelet concentrates as a treatment of horses with osteoarthritis: a preliminary pilot clinical study. J Equin Vet Sci 27;4:167–170

   Not in our library

8. 8.

   Cerza F, Carnì S, Carcangiu A, Di Vavo I, Schiavilla V, Pecora A, De Biasi G, Ciuffreda M. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012.

   Not in our library10.1177/0363546512461902

9. 9.

   Cole BJ, Seroyer ST, Filardo G, Bajaj S, Fortier LA. Platelet-rich plasma: where are we now and where are we going? Sports Health. 2010;2(3):203-210.

   Not in our library10.1177/1941738110366385

10. 10.

    Della Villa S, Kon E, Filardo G, Ricci M, Vincentelli F, Delcogliano M, Marcacci M. Does intensive rehabilitation permit early return to sport without compromising the clinical outcome after arthroscopic autologous chondrocyte implantation in highly competitive athletes? Am J Sports Med. 2010;38(1):68-77.

    Not in our library10.1177/0363546509348490

11. 11.

    Drengk A, Zapf A, Stürmer EK, Stürmer KM, Frosch KH. Influence of platelet-rich plasma on chondrogenic differentiation and proliferation of chondrocytes and mesenchymal stem cells. Cells Tissues Organs. 2009;189(5):317-326.

    Not in our library10.1159/000151290

12. 12.

    Filardo G, Di Matteo B, Kon E. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Letter to editor. Am J Sports Med. 2013;41(9):NP42-NP44.

    Not in our library10.1177/0363546513502635

13. 13.

    Filardo G, Kon E, Buda R, Timoncini A, Di Martino A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2011;19(4):528-535.

    Not in our library10.1007/s00167-010-1238-6

14. 14.
    Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial · 2012

    No notice
15. 15.

    Filardo G, Kon E, Di Martino A, Iacono F, Marcacci M. Arthroscopic second-generation autologous chondrocyte implantation: a prospective 7-year follow-up study. Am J Sports Med. 2011;39(10):2153-2160.

    Not in our library10.1177/0363546511415658

16. 16.

    Filardo G, Kon E, Di Martino A, Patella S, Altadonna G, Balboni F, Bragonzoni L, Visani A, Marcacci M. Second-generation arthroscopic autologous chondrocyte implantation for the treatment of degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2012;20(9):1704-1713.

    Not in our library10.1007/s00167-011-1732-5

17. 17.

    Filardo G, Kon E, Pereira Ruiz MT, Vaccaro F, Guitaldi R, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M. Platelet-rich plasma intra-articular injections for cartilage degeneration and osteoarthritis: single- versus double-spinning approach. Knee Surg Sports Traumatol Arthrosc. 2012;20(10):20-2091.

    Not in our library10.1007/s00167-011-1837-x

18. 18.

    Filardo G, Vannini F, Marcacci M, Andriolo L, Ferruzzi A, Giannini S, Kon E. Matrix-assisted autologous chondrocyte transplantation for cartilage regeneration in osteoarthritic knees: results and failures at midterm follow-up. Am J Sports Med. 2013;41(1):95-100.

    Not in our library10.1177/0363546512463675

19. 19.

    Gaissmaier C, Fritz J, Krackhardt T, Flesch I, Aicher WK, Ashammakhi N. Effect of human platelet supernatant on proliferation and matrix synthesis of human articular chondrocytes in monolayer and three-dimensional alginate cultures. Biomaterials. 2005;26(14):1953-1960.

    Not in our library10.1016/j.biomaterials.2004.06.031

20. 20.

    Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Sports Health. 2012;4(2):162-172.

    Not in our library10.1177/1941738111431801

21. 21.

    Gomoll AH, Filardo G, Almqvist FK, Bugbee WD, Jelic M, Monllau JC, Puddu G, Rodkey WG, Verdonk P, Verdonk R, Zaffagnini S, Marcacci M. Surgical treatment for early osteoarthritis. Part II: allografts and concurrent procedures. Knee Surg Sports Traumatol Arthrosc. 2012;20(3):468-486.

    Not in our library10.1007/s00167-011-1714-7

22. 22.

    Gomoll AH, Filardo G, de Girolamo L, Espregueira-Mendes J, Marcacci M, Rodkey WG, Steadman JR, Zaffagnini S, Kon E. Surgical treatment for early osteoarthritis. Part I: cartilage repair procedures. Knee Surg Sports Traumatol Arthrosc. 2012;20(3):450-466.

    Not in our library10.1007/s00167-011-1780-x

23. 23.

    Gonzales VK, de Mulder EL, de Boer T, Hannink G, van Tienen TG, van Heerde WL, Buma P. Platelet-rich plasma can replace fetal bovine serum in human meniscus cell cultures. Tissue Eng Part C Methods. 2013.

    Not in our library10.1089/ten.tec.2013.0009

24. 24.

    Guner S, Buyukbebeci O. Analyzing the effects of platelet gel on knee osteoarthritis in the rat model. Clin Appl Thromb Hemost. 2012.

    Not in our library10.1177/1076029612452117

25. 25.

    Hapa O, Çakici H, Yüksel HY, Fırat T, Kükner A, Aygün H. Does platelet-rich plasma enhance microfracture treatment for chronic focal chondral defects? An in vivo study performed in a rat model. Acta Orthop Traumatol Turc. 2013;47(3):201-207.

    Not in our library10.3944/aott.2013.2928

26. 26.

    Hart R, Safi A, Komzák M, Jajtner P, Puskeiler M, Hartová P. Platelet-rich plasma in patients with tibiofemoral cartilage degeneration. Arch Orthop Trauma Surg. 2013.

    Not in our library10.1007/s00402-013-1782-x

27. 27.

    Heijink A, Gomoll AH, Madry H, Drobnič M, Filardo G, Espregueira-Mendes J, Van Dijk CN. Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surg Sports Traumatol Arthrosc. 2012;20(3):423-435.

    Not in our library10.1007/s00167-011-1818-0

28. 28.

    Hildner F, Eder MJ, Hofer K, Aberl J, Redl H, van Griensven M, Gabriel C, Peterbauer-Scherb A. Human platelet lysate successfully promotes proliferation and subsequent chondrogenic differentiation of adipose-derived stem cells: a comparison with articular chondrocytes. J Tissue Eng Regen Med. 2013.

    Not in our library10.1002/term.1649

29. 29.

    Hunter DJ, Felson DT (2006). Osteoarthritis BMJ 18;332(7542):639–642

    Not in our library10.1136/bmj.332.7542.639

30. 30.

    Ishida K, Kuroda R, Miwa M, Tabata Y, Hokugo A, Kawamoto T, Sasaki K, Doita M, Kurosaka M. The regenerative effects of platelet-rich plasma on meniscal cells in vitro and its in vivo application with biodegradable gelatin hydrogel. Tissue Eng. 2007;13(5):1103-1112.

    Not in our library10.1089/ten.2006.0193

31. 31.

    Jang SJ, Kim JD, Cha SS. Platelet-rich plasma (PRP) injections as an effective treatment for early osteoarthritis. Eur J Orthop Surg Traumatol. 2013;23(5):573-580.

    Not in our library10.1007/s00590-012-1037-5

32. 32.

    Kakudo N, Minakata T, Mitsui T, Kushida S, Notodihardjo FZ, Kusumoto K. Proliferation-promoting effect of platelet-rich plasma on human adipose-derived stem cells and human dermal fibroblasts. Plast Reconstr Surg. 2008;122(5):1352-1360.

    Not in our library10.1097/prs.0b013e3181882046

33. 33.

    Kaps C, Loch A, Haisch A, Smolian H, Burmester GR, Häupl T, Sittinger M. Human platelet supernatant promotes proliferation but not differentiation of articular chondrocytes. Med Biol Eng Comput. 2002;40(4):485-490.

    Not in our library10.1007/bf02345083

34. 34.

    Koh YG, Choi YJ. Infrapatellar fat pad-derived mesenchymal stem cell therapy for knee osteoarthritis. Knee. 2012;19(6):902-907.

    Not in our library10.1016/j.knee.2012.04.001

35. 35.

    Koh YG, Jo SB, Kwon OR, Suh DS, Lee SW, Park SH, Choi YJ. Mesenchymal stem cell injections improve symptoms of knee osteoarthritis. Arthroscopy. 2013;29(4):748-755.

    Not in our library10.1016/j.arthro.2012.11.017

36. 36.

    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. 2010;18(4):472-479.

    Not in our library10.1007/s00167-009-0940-8

37. 37.

    Kon E, Filardo G, Condello V, Collarile M, Di Martino A, Zorzi C, Marcacci M. Second-generation autologous chondrocyte implantation: results in patients older than 40 years. Am J Sports Med. 2011;39(8):1668-1675.

    Not in our library10.1177/0363546511404675

38. 38.

    Kon E, Filardo G, Di Martino A, Marcacci M. Platelet-rich plasma (PRP) to treat sports injuries: evidence to support its use. Knee Surg Sports Traumatol Arthrosc. 2011;19(4):516-527.

    Not in our library10.1007/s00167-010-1306-y

39. 39.

    Kon E, Filardo G, Drobnic M, Madry H, Jelic M, van Dijk N, Della Villa S. Non-surgical management of early knee osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2012;20(3):436-449.

    Not in our library10.1007/s00167-011-1713-8

40. 40.

    Kon E, Filardo G, Matteo BD, Marcacci M. PRP for the treatment of cartilage pathology. Open Orthop J. 2013;3(7):120-128.

    Not in our library10.2174/1874325001307010120

Cited by papers we hold 3

• BONE GRAFTING ENHANCED BY PLATELET-RICH PLASMA IN TREATMENT OF AVASCULAR NECROSIS OF FEMORAL HEAD · 2018
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• Canine Platelet Rich Plasma Systems: A Prospective Analysis · 2016
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• Platelet-Rich Plasma: The Choice of Activation Method Affects the Release of Bioactive Molecules · 2016
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