Hand Clin. 2012 Nov;28(4):481-91. doi: 10.1016/j.hcl.2012.08.008.

Platelet-rich plasma and the upper extremity.

Mishra A, Randelli P, Barr C, Talamonti T, Ragone V, Cabitza P.
Source
Department of Orthopaedic Surgery, Menlo Medical Clinic, Stanford University Medical Center, 1300 Crane Street, Menlo Park, CA 94025, USA. am@totaltendon.com
Abstract Platelet-rich plasma (PRP) is a fraction of whole blood containing powerful growth factors and cytokines. Preclinical studies suggest PRP may be useful for tendon repair or regeneration. Clinical investigations have focused on the treatment of chronic lateral epicondylar tendinopathy and rotator cuff pathology. Multiple controlled studies support the use of PRP for chronic tennis elbow. Rotator cuff studies, however, have produced conflicting results based on PRP formulation, surgical technique, and size of tendon tear. This article explores the scientific rational for using PRP, its various formulations, and the emerging clinical data. Future potential applications are also explored.
Copyright © 2012 Elsevier Inc. All rights reserved.
PMID:
23101598
[PubMed - in process]

J Orthop Res. 2012 Dec 31. doi: 10.1002/jor.22301. [Epub ahead of print]

Platelet-rich plasma protects rotator cuff-derived cells from the deleterious effects of triamcinolone acetonide.

Muto T, Kokubu T, Mifune Y, Sakata R, Nagura I, Nishimoto H, Harada Y, Nishida K, Kuroda R, Kurosaka M.
Source
Department of Orthopaedic Surgery, Kobe University, Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan.
Abstract
Triamcinolone acetonide (TA) injections are widely used to treat enthesopathy, but they may induce adverse effects such as tendon impairment and rupture. Platelet-rich plasma (PRP) is a blood fraction containing high platelet concentrations and various growth factors that play a role in tissue repair processes. The purpose of this study is to investigate whether TA has deleterious effects on human rotator cuff-derived cells, and if PRP can protect these cells from the effects of TA. Human rotator cuff-derived cells were cultured with and without TA and PRP, and the culture without any additive served as the control. Cell morphology was assessed at days 7 and 21. Cell viability was evaluated at days 1, 7, 14, and 21 by a water-soluble tetrazolium salt assay. Induction of apoptosis was measured by immunofluorescence staining and flow cytometry at day 7. Induction of cleaved caspase-3 was measured by immunofluorescence staining at day 7. The cells cultured with TA had a flattened and polygonal shape at day 7. The cells cultured with both TA and PRP were similar in appearance to control cells. Exposure to TA also significantly decreased cell viability, but cell viability did not decrease when PRP was added along with TA. The number of apoptotic cells increased with TA exposure, while addition of PRP prevented cell apoptosis. In conclusion, the deleterious effect of TA was prevented by PRP, which can be used as a protective agent for patients receiving local TA injections. © 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
Copyright © 2012 Orthopaedic Research Society

JECT. 2007;39:177–182
The Journal of The American Society of Extra-Corporeal Technology

Autologous Platelet Gel and Platelet-Poor Plasma Reduce Pain With Total Shoulder Arthroplasty

Douglas P. Zavadil, MPS, CCP, LCP;* C. Craig Satterlee, MD;† Jaime M. Costigan, RN;‡ David W. Holt, MA, CCT;§ Valerie K. Shostrom, MS¶
*Penn View Perfusion, Inc., North Kansas City Hospital, North Kansas City, Missouri; †University of Missouri-Kansas City, Kansas City, Missouri; ‡Drisko, Fee & Parkins, North Kansas City, Missouri; §Division of Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska; and ¶Department of Preventive and Societal Medicine, University of Nebraska Medical Center, Omaha, Nebraska
Presented at the 8th Annual Emerging Technology Cancun Perfusion Conference, Cancun, Mexico, November 8–12, 2006
Abstract: The recovery of patients undergoing total shoulder arthroplasty (TSA) can be adversely affected by a number of complications. Autologous platelet gel (APG), produced by ac- tivating platelet-rich plasma (PRP), has been shown to improve hemostasis and wound healing and reduce infections in some surgical procedures. Activated platelet-poor plasma (PPP) has also been used as a hemostatic agent. This study examines the effects of APG and PPP treatment on TSA patients postopera- tively. After Institutional Review Board (IRB) approval, 40 pa- tients undergoing TSA at our institution were prospectively en- rolled in our study. They were randomized into either a control (n 􏰃 20) or study (n 􏰃 20) group, with the study group receiving APG and PPP treatment. Preoperative demographic data, pre- and postoperative laboratory data, pain scores, pain medication, complications, pre- and postoperative range of motion measure- ments, and postoperative lengths of stay were recorded for each group. The preoperative internal rotation index was significantly higher in the control group compared with treatment patients (4.64 ± 4.46 vs. 1.88 ± 2.44, p < .05). The percent hemoglobin retained postoperatively was higher in the treatment group at 24 (84.54 ± 5.32 vs. 79.87 ± 8.73) and 72 hours (87.46 ± 16.03 vs. 76.70 vs. 5.96), but neither difference reached statistical signifi- cance. The treatment group had significantly lower pain scores (p 􏰃 .007) and total fentanyl requirements (p < .05) compared with control patients. The internal rotation index improvement factor (postoperative internal rotation index/preoperative inter- nal rotation index) was significantly higher in the treatment group vs. the control group (p < .05). Although it did not reach statistical significance, the treatment group was discharged al- most 9 hours earlier than the control group (64.44 ± 15.23 vs. 73.39 ± 15.37). APG and PPP treatment decreased pain and provided a greater increase in internal rotation measurements postoperatively.
Keywords: osteoarthritis, total shoulder arthro- plasty, platelet-rich plasma, platelet-poor plasma, autologous platelet gel, growth factors. JECT. 2007;39:177–182

Effectiveness of Platelet-rich Plasma Injection for Rotator Cuff Tendinopathy (RCT)

Scarpon, M, Rabago, D, Snell, E, Demeop, P, Ruppert, K, Pritchard, P, Arbogast, G, Wilson, JJ, Balzano, JF
Source: AdvHealth Med. 2013 Mar;2(2):26-31. doi: 10.7453/gahmj.2012.054
Abstract: Eighteen participants received one ultrasound-guided injection of 3.0 mL of 1% xylocaine followed by 3.5 mL of PRP at the lesion and surrounding tendon. Follow-up was performed at 52 weeks.
Conclusion: A single injection of PRP resulted in safe, significant, sustained improvement of pain, function, and MRI outcomes in participants with refractory RCT.