31 Growth Factor Release70 % within 10 minutesNearly 100% within 1 hr
32 PRP Preparations Systems Several AvailableQualitative and Quantitative VariabilityVolume of autologous bloodCentrifuge rate/timeDelivery MethodActivating AgentLeukocyte concentration (?)Final PRP volumeFinal Platelet and Growth Factor Concentration
45 Intraoperative Use Total Knee arthroplasty ACL reconstruction Achilles Tendon RepairRotator Cuff RepairAcute Articular Cartilage Repair
46 Review of the literature Numerous basic science, animal studies, and small case reportsFew controlled clinical studiesMajority of studies are small, anecdotal, and underpoweredNon-standardized techniques
48 Randomized controlled trial; Level 1 of evidence Ongoing Positive Effect of Platelet-Rich Plasma Versus Corticosteroid Injection in Lateral Epicondylitis: A Double-Blind Randomized Controlled Trial With 2-Year Follow-Up. Gosens T, Peerbooms JC, van Laar W, den Oudsten BL.Randomized controlled trial; Level 1 of evidencePRP group (n = 51) or the corticosteroid group (n = 49)PRP group was more often successfully treated than the corticosteroid group (P < .0001). Success was defined as a reduction of 25% on VAS or DASH scores without a re-intervention after 2 years.
49 PRP group (n = 27) or placebo group (n = 27) Platelet-Rich Plasma Injection for Chronic Achilles Tendinopathy A Randomized Controlled TrialRobert J. de Vos, MD; Adam Weir, MBBS; Hans T. M. van Schie, DVM, PhD; Sita M. A. Bierma-Zeinstra, PhD; Jan A. N. Verhaar, MD, PhD; Harrie Weinans, PhD; Johannes L. Tol, MD, PhDEccentric exercises (usual care) with either a PRP injection (PRP group) or saline injection (placebo group)PRP group (n = 27) or placebo group (n = 27)The mean VISA-A score improved significantly after 24 weeks in the PRP group and in the placebo group, but the increase was not significantly different between both groups
50 Sample size of 30 patients in each group Platelet-rich Fibrin Matrix in Arthroscopic Rotator Cuff Repair: A Prospective, Randomized Study Stephen C Weber, MD Sacramento CA Jeffrey I Kauffman, MD Sacramento CASample size of 30 patients in each groupSerial VAS scores were obtained, as well as SST scores at each interval. Final scores for each group included UCLA and ASES scores.Early follow-up does not show significant improvement in perioperative pain or clinical outcome.
51 Prospective study of thirty patients No controls Platelet Rich Plasma (PRP) Effectively Treats Chronic Achilles Tendonosis Raymond R Monto, MDProspective study of thirty patientsNo controlsAOFAS scores improved to 92 at 6 months. Resolution of Achilles abnormalities were seen in post treatment MRI/ultrasound studies and 28/30 were clinically satisfied with their clinical results.
52 Literature Summary Greatest support in treating tendinopathy Lateral EpicondylitisPatellar TendinopathyAchilles TendinopathyPlantar FasciitisCaution with Acute InjuriesRisk of FibrosisReturn to activity too early
53 Future PRP promising, but not proven Appropriately powered studies Sophisticated models of healingMore precise formulations of PRPNarrower indications, but more definitive
54 My Protocol Treatment of last resort prior to surgery Indicated for chronic tendinopathiesPerformed under ultrasound guidanceNSAIDS discontinuation 1 week prior and 2 weeks post procedureActivity modification for 7 days