After an injury such as to the anterior cruciate ligament of the knee, there’s immediate pain and inflammation. The orthopedic surgeons have considered the therapeutic use of platelet-rich plasma (PRP) to control inflammation and enhance repair.
What Exactly is Platelet-Rich Plasma?
Platelet-rich plasma is a term for plasma products that come from whole blood. PRP can vary, depending on how the doctor decides to take the sample. The PRP contains different amounts of red blood cells, platelets, leukocytes and plasma proteins.
If you check with the American Association of Blood Banks, they’ll describe PRP as the plasma that results after a single spin of whole blood in a centrifuge where platelets are enriched but other cell types are reduced in number sometimes to undetectable numbers. The time and speed of the centrifuge affects the number and concentration of platelets and other cell types in the blood.
Commercially available PRP solutions vary greatly. That’s why it’s always important to find out what type of PRP you are going to get if you are considering PRP as treatment for ACL repair.
Why Do Doctors Want to Use PRP?
PRP products are used for the following reasons:
• They facilitate recruitment, proliferation, and maturation of cells that regenerate tendon, bone, muscle, ligament and cartilage.
• Platelets are the first responders in injury.
• Platelets release biomolecules that control all types of biological activities, more than 1500 different proteins. Many of these are growth factors, cytokines and chemokines that are critical for tissue regeneration.
• Platelets modulate the return to normal of the tissue through inflammatory responses.
• Platelets provide antimicrobial actions.
Some of the growth factors that are found in platelets and their purpose in the body include:
PDGF – Important for cell proliferation, chemoattraction
TGF-B – Promotes the synthesis of the matrix
VEGF – For angiogenesis
EGF – For cell proliferation
ECGF – Endothelial cell proliferation, angiogenesis
bFGF – Mediates angiogenesis
IGF-I, II-Cell proliferation, maturation of bone cells for the bone matrix
HGF – Cell growth and motility of epithelial cells
PDAF – Angiogenesis
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What Does the Research Say About the Use of PRP for ACL Repair?
1. There is A Place for PRP in Arthroscopy
In 2013, doctors at Stanford University in the Department of Orthopedic Surgery weren’t too convinced that PRP could be beneficial for ligament and meniscal healing. They state that “some studies support a possible benefit… and preliminary animal studies point to a potential role for PRP in primary ACL repair.”
2. PRP Good for Sports Medicine
Other doctors in Paris reported similar findings when they reviewed the literature on the topic, doubting the effectiveness of PRP during surgery for damaged tissues in arthroscopy (the treatment of joints).
They believe that PRP, in some protocols with specific concentration, should be more efficient than current therapies in the treatment of knee arthritis in its early stages.
However, they are quite specific in saying this only would apply to the field of rheumatology or sports medicine. It doesn’t apply to times when surgery is done for the knee ligaments and tendons.
3. Doctors Tested Double and Single Spinning PRP Preparations
In 2014, a large study review hit the medical journals. This one was done by doctors at the orthopedic and radiology departments of Clinica Universidad de Navarra in Pamplona, Spain.
They compared two different platelet-rich plasma (PRP) preparations used during reconstruction of the anterior cruciate ligament in the knees of 150 patients. The two different preparations were either a double-spinning platelet enriched gel with white blood cells or a non-gel group. Each of these were tried in a group of 50 patients. Another 50 patients were treated with a PRP from a single spinning procedure without the white blood cells.
The doctors tested the patients for inflammation, pain, how much movement the knee was capable of doing, and did an MRI six months later, too.
Twenty-four hours after surgery, the group that had the single-spinning PRP had the most significant improvement in inflammation and swelling. However, there wasn’t any other significant difference between clinical scores or MRI scores amongst the groups.
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4. Doctors Say the Results Still Aren’t Good Enough
By 2015, Italian doctors from the Jesi Civil Hospital produced mixed results in their study about the use of PRP for ACL rupture in patients. The doctors tested 14 patients that had surgical reconstruction with the PRP and another 14 patients that had surgical reconstruction without the PRP. After a year, the doctors then did an MRI evaluation although clinic visits were also recorded after six months, 1 year and 2 years after the surgery.
The patients that had the PRP showed a significantly higher clinical improvement but when their MRI images were examined, the doctors couldn’t see much difference. They said there was no difference in the stability of the knee. However, there was short-term improvement in the knee function and in the future, results may improve from changed techniques.
Right now as it stands, PRP is still in the category of hopefulness for ACL repair. This doesn’t mean that things will stay the same. With the rate of change in the stem cell field, it’s possible that new discoveries will be revealed in the next few years and in the next few studies.
Stay tuned for our updates – and don’t give up – regenerative medicine will soon find answers.