Hackensack University Medical Center Specialist Calls for Standardization of Platelet-Rich Plasma Preparations for Musculoskeletal Conditions

Literature review calls out variability and offers guidance for application of increasingly popular orthobiologic treatment

November 15, 2024

While platelet-rich plasma (PRP) has risen in popularity as an orthobiologic treatment and potential alternative treatment for multiple musculoskeletal conditions, there remains a vast variability among PRP preparations that affect therapeutic efficacy. Hackensack University Medical Center sports medicine physician Chris Cherian, M.D., and field peers offer insight on the current PRP treatments and protocols and advises of the need for further study of this promising treatment.

Dr. Cherian contributed to a thorough literature review of these relatively new and increasingly popular treatments published in the Biologic Orthopedic Journal. In Optimizing Platelet-Rich Plasma (PRP) Injections: A Narrative Review, the authors aim to provide better clarity regarding the optimal characteristics for PRP treatments regarding tendon and ligament injuries as well as articular and muscular pathology.

PRP treatments take advantage of the physiologic role of platelets in the healing cascade. This publication provides clarity regarding its potential as it releases various growth factors such as platelet-derived growth factor (PDGF), transforming growth factor beta-1 (TGF-β1), and vascular endothelial growth factor (VEGF).

Their analysis called for standardization to allow physicians to effectively make decisions about each option’s therapeutic efficacy for an individual patient’s needs. The review highlights the use of the PLRA system of classification to guide as a means of standardization and guidance for specific tissue pathology.

The analysis notes several factors physicians should take in to account when prescribing PRP treatment. Diet and exercise, for example, can influence platelet and growth factor released from platelets. Additionally, the area of tissue pathology should factor into PRP selection. RBCs should be removed from the PRP product regardless of the target tissue.

However, optimal platelet counts, presence or absence of leukocytes, and activator use require further study and clear definition to determine the best options for optimal outcomes.

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