Advances with platelet rich plasma therapies for tendon regeneration

ABSTRACT

Introduction: PRPs can be used in the management of tendinopathy if we improve our understanding of pathophysiology and to integrate molecular knowledge about PRP participation in healing mechanisms.

Areas covered: We provide new insights into the pathophysiology of tendinopathy, PRP therapies, and the potential links between both. We discuss the place of PRP in promoting tendon repair within what is currently understood regarding the role of PRP molecules in promoting tendon regeneration.

Expert opinion: Development of PRP treatments is challenging because a typical group of patients with tendinopathy does not exist, as it affects multiple segments of the population. Moreover, the pathophysiology and origin of pain are not elucidated yet. Although some degree of success has been achieved, PRP is not considered standard medical treatment, and it is largely not paid nor reimbursed by insurance companies. However, the arguments for using PRP in tendinopathy are increasing, and its potential to rebalance inflammation merits further research. Moreover, PRP contains tendoinductive factors that can drive the fate of stem cells. Tailoring PRPs to the specific needs of the host tendon has not been possible to date, because unanswered questions remain about the characteristics of tendinopathy within the different stages of progression.

KEYWORDS:

• Cells
• cytokines
• growth factors
• healing
• platelet-rich plasma
• tendinopathy

Article Highlights

• The foundation of PRP application is to modify the molecular milieu by providing supraphysiological concentrations of platelets (and optionally leukocytes) at the injured/pathological tissues mimicking the initial stages of healing.

• However, the efficacy of PRP is controversial in tendinopathies, given the contrasting results from well performed randomized controlled trials.

• When extending current knowledge about PRP efficacy, it is important to consider the diversity of PRP formulations and provide clinical results with the full description of the PRP used and the protocol for application.

• The simplest way to customize PRP for the specific application consists of selecting among clinically available formulations, the timing of application, and the number of doses. These essentials of PRP treatment have not yet been optimized.

• Another logical step forward is to produce combinatory treatments by identifying what really matters to associate PRP with selected molecular inhibitors or enhancers for each clinical application. PRP has been combined with different cell phenotypes to treat tendon conditions.

• PRP is not a monotherapy; it should be used as part of a tendinopathy management program including load and pain management.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Additional information

Funding

ISCiii cofunded with FEDER PI13/01707