91桃色

Platelet-rich plasma; PRP therapy; Orthobiologics; Regenerative medicine; Musculoskeletal healing; Growth factors; Cytokines

Introduction

Platelet-rich plasma (PRP) has gained widespread attention in orthopedics as a regenerative therapy designed to enhance musculoskeletal healing. PRP is an autologous blood-derived product containing a high concentration of platelets, growth factors, and cytokines that play a crucial role in tissue repair and regeneration. By leveraging the body’s natural healing mechanisms, PRP has been proposed as a treatment for a variety of orthopedic conditions, including osteoarthritis, tendon and ligament injuries, muscle strains, and fractures [1]. The therapeutic potential of PRP lies in its ability to modulate inflammation, promote angiogenesis, and stimulate cellular proliferation and differentiation. Platelets release key bioactive molecules, such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), and vascular endothelial growth factor (VEGF), which contribute to tissue repair by enhancing extracellular matrix synthesis and collagen production. However, despite its biological promise, PRP remains a topic of considerable debate due to variations in preparation techniques, platelet concentrations, and clinical outcomes [2].

One of the main challenges in PRP therapy is the lack of standardization in its formulation and application. Differences in centrifugation protocols, leukocyte content, and platelet activation methods can influence its therapeutic efficacy. Furthermore, clinical studies on PRP have produced mixed results, with some demonstrating significant pain relief and functional improvement, while others suggest minimal benefits compared to placebo or conventional treatments such as corticosteroid injections and hyaluronic acid therapy. Given the increasing interest in PRP as an alternative to surgical interventions and pharmacologic treatments, it is essential to critically evaluate its mechanisms of action, clinical efficacy, and the factors contributing to its controversial status. This review aims to provide an in-depth analysis of PRP in orthopedics, exploring its biological foundation, evidence-based applications, and ongoing challenges in its clinical use [3].

Discussion

Platelet-rich plasma (PRP) has emerged as a promising orthobiologic therapy for musculoskeletal disorders, yet its clinical efficacy remains a subject of ongoing debate. The regenerative potential of PRP is largely attributed to its high concentration of platelets, which release bioactive molecules that regulate inflammation, promote angiogenesis, and enhance tissue repair. Despite these biological advantages, variability in PRP preparation, patient response, and study outcomes has led to inconsistent clinical findings [4].

Mechanisms of PRP in Musculoskeletal Healing

The therapeutic effects of PRP are primarily mediated through the release of growth factors such as platelet-derived growth factor (PDGF), transforming growth factor-beta (TGF-β), vascular endothelial growth factor (VEGF), and insulin-like growth factor-1 (IGF-1). These factors stimulate cell migration, collagen synthesis, and extracellular matrix remodeling, which are critical for tendon, ligament, and cartilage repair [5]. Additionally, PRP has been shown to modulate inflammatory responses by reducing the expression of pro-inflammatory cytokines, thereby creating a favorable environment for tissue regeneration. However, the presence of leukocytes in PRP preparations has raised concerns regarding its pro-inflammatory effects. Leukocyte-rich PRP (LR-PRP) is believed to enhance antimicrobial activity and modulate immune responses, but it may also contribute to increased inflammation and catabolic activity in certain tissues. In contrast, leukocyte-poor PRP (LP-PRP) is associated with reduced inflammation and may be more suitable for intra-articular applications such as osteoarthritis treatment. The choice between LR-PRP and LP-PRP remains a critical factor influencing clinical outcomes [6].

Clinical Efficacy in Orthopedic Applications

PRP has been widely studied for its use in treating various orthopedic conditions, including osteoarthritis, tendon and ligament injuries, and fracture healing.

Osteoarthritis (OA): PRP has been proposed as an alternative to corticosteroids and hyaluronic acid injections for managing knee osteoarthritis. Several studies have demonstrated PRP’s ability to reduce pain and improve joint function by enhancing chondrocyte proliferation and inhibiting inflammatory mediators. However, conflicting results exist, with some meta-analyses indicating only modest benefits over placebo or conventional therapies [7].

Tendon and Ligament Injuries: PRP has been explored for conditions such as rotator cuff tears, Achilles tendinopathy, and anterior cruciate ligament (ACL) reconstruction. While preclinical studies suggest PRP enhances tendon healing by increasing collagen synthesis, clinical trials have produced mixed results. Variability in PRP composition, delivery methods, and patient factors likely contribute to these inconsistencies.

Fracture Healing: PRP has been investigated as an adjunct to bone grafting and fracture repair, with some evidence supporting its role in accelerating bone regeneration. However, its effectiveness compared to established bone healing techniques remains unclear [8].

Challenges and Controversies

Despite its growing use in orthopedic practice, several challenges hinder the widespread acceptance of PRP:

Lack of Standardization: Differences in PRP preparation protocols, including centrifugation speeds, platelet concentration, and leukocyte content, create significant variability in study results and clinical efficacy [9].

Heterogeneous Patient Response: Individual factors such as age, comorbidities, and baseline inflammation levels influence PRP&rsquos therapeutic effects, making it difficult to predict treatment outcomes.

Inconsistent Study Findings: While some randomized controlled trials (RCTs) report substantial benefits, others show minimal or no improvement compared to placebo or standard care.

Regulatory and Cost Considerations: PRP is considered an experimental therapy in many healthcare systems, limiting insurance coverage and accessibility for patients [10].

Conclusion

PRP holds significant potential as a regenerative therapy for musculoskeletal conditions, but its clinical application remains limited by variability in preparation methods, patient response, and inconsistent study outcomes. While emerging evidence supports PRP&rsquos role in osteoarthritis and tendon repair, further research is needed to refine its protocols and improve treatment efficacy. Standardization, patient selection criteria, and combination strategies will be critical in advancing PRP&rsquos role in orthopedic practice.

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