Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Case Report
Clinical Images
Research Article
Review Article
Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Search in posts
Search in pages
Filter by Categories
Case Report
Clinical Images
Research Article
Review Article
View/Download PDF

Translate this page into:

Review Article
2024
:3;
100287
doi:
10.1016/j.jorep.2023.100287

Therapeutic uses of platelet-rich plasma (PRP) in sport injuries – A narrative review

, , ,
a Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
b Rangaraya Medical College, Kakinada, India
c Squad Medicine and Research, India
d Tbilisi State Medical University, Georgia

∗Corresponding author: Tarun Kumar Suvvari. drtarunsuvvariresearch@gmail.com

Received: , Accepted: ,
The Author(s)
Disclaimer:
This article was originally published by Reed Elsevier India Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.

Abstract

Abstract

Sports offer numerous health benefits, contributing to growth, development, physical fitness, and mental well-being. However, injuries are an inevitable part of sports, affecting both professional athletes and casual participants. The incidence of sports-related injuries has risen significantly due to increased participation, heightened competitiveness, inadequate injury prevention techniques, improper sporting gear, insufficient training, and overuse.

ology: A comprehensive literature search was performed in multiple databases such as PUBMED and SCOPUS. Relevant studies on therapeutic uses of platelet-rich plasma (PRP) in sports injuries were included. The findings provide a comprehensive overview of the topic.

Platelet-Rich Plasma (PRP) is a regenerative, minimally invasive, non-surgical procedure that accelerates healing by utilizing concentrated bioactive factors from the body. PRP has shown promising results in treating conditions such as patellar tendonitis, Achilles tendonitis, tennis elbow, partial rotator cuff tears, ligament tears, and mild to moderate arthritis. Following a PRP injection, athletes typically undergo a short period of rest from sports activities while attending rehabilitation therapy. This approach helps optimize healing and ensures an optimal outcome.

PRP has shown great promise as a treatment modality for sports injuries. While further research is needed to optimize PRP protocols and understand its mechanisms of action in sports injuries, it holds significant potential for enhancing the recovery and rehabilitation of athletes, ultimately contributing to improved outcomes in the field of sports medicine.

Keywords

Platelet-rich plasma
Sports injuries
Therapeutics
Rehabilitation
Sports medicine
1

1 Introduction

Musculoskeletal injuries in sports can occur due to trauma, improper training techniques, chronic overuse, and inadequate injury prevention measures. While many of these injuries can be managed conservatively with approaches such as NSAIDs, physiotherapy, rehabilitation, and rest, there are certain chronic injuries that do not respond well to conservative treatments and may require conventional surgical intervention. These chronic pathologies often involve microstructural damage to tissues and bones, which may not fully recover even after surgery. Such injuries can have a significant impact on athletes, potentially cutting short their careers and negatively affecting their quality of life. This is where regenerative procedures like Platelet-Rich Plasma (PRP) come into play.1,2 From a clinical perspective, regenerative sports medicine focuses on injuries related to sports activities and aging, involving various components of the musculoskeletal system such as menisci, ligaments, tendons, cartilage, and bones. PRP has shown its utility as an interventional therapy for sports injuries in specific cases. PRP is composed of over 1000 bioactive proteins that play crucial roles in healing, clot formation, and hemostasis. These include fibroblast growth factor (FGF), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), transforming growth factor (TGF), and epidermal growth factor (EGF).1,2 (Table 1).

Table 1 Application of PRP in sports medicine and traumatology.
Condition Application of PRP
Achilles Tendon Rupture Effective in promoting tendon healing and accelerating recovery
Rotator Cuff Tears Facilitates the healing process and improves functional outcomes
Anterior Cruciate Ligament Enhances graft-bone integration and aids in the recovery after ACL repair
Tennis Elbow Alleviates pain, improves grip strength, and enhances overall function
Golf Elbow Reduces symptoms, improves functional outcomes, and speeds up recovery
Jumper's Knee and Runner's Knee Provides pain relief, enhances functional outcomes, and aids in healing

PRP stimulates human tenocytes to produce matrix-degrading enzymes and endogenous growth factors, promoting cell proliferation and collagen formation. PRP is synthesized using the athlete's own blood. After collecting a blood sample, it is centrifuged to separate its components into platelets, white blood cells (WBCs), and red blood cells (RBCs) using differential centrifugation. The concentrated platelets are then extracted and combined with the remaining plasma before being injected into the injured area.3 Ultrasound imaging is often employed to ensure accurate application and placement of the PRP at the site of injury. The optimal time to create PRP from autogenous whole blood is just prior to or at the beginning of surgery when platelets naturally accumulate at the surgical site to initiate clotting and healing. This slightly reduces the overall platelet count. Additionally, the platelet numbers can be further diluted by intravenous fluids during surgery. PRP remains stable and sterile in an anticoagulated state for up to 8 h after creation. Therefore, it maintains its efficacy and sterility during longer procedures as it does when used immediately. Following centrifugation, the platelet-rich portion gradually mixes back with the platelet-poor plasma (PPP), leading to a decrease in the platelet concentration of the PRP preparation. Hence, it is crucial to separate the PRP from the PPP as soon as possible.4,5

1.1

1.1 Platelet-rich Plasma (PRP)

Platelet-rich plasma (PRP) refers to the fraction of autologous blood plasma that contains a platelet concentration higher than the baseline. The normal range of platelet values in blood varies from 150,000/microliter to 350,000/microliter.5 Scientific evidence has already demonstrated the ability of PRP with a platelet concentration of 1,000,000/μl to enhance bone and muscle recovery. This platelet concentration serves as the operational definition of PRP currently. Lower doses of platelets cannot be relied upon to improve wound healing. PRP not only contains a high quantity of platelets but also includes the complete complement of clotting factors, growth factors (GFs), chemokines, cytokines, and other plasma proteins.6–9

1.2

1.2 Mechanism of action

Thrombocytes, also known as platelets, are produced in the bone marrow. They are small, nucleated, discoid-shaped cells with the lowest density among other cellular components, measuring approximately 1.5–3 μm in diameter.10,11 The normal platelet count ranges from 150,000 to 450,000 platelets per μL.12 Platelets play a crucial role in the body as a significant source of growth factors (GFs) and are involved in the clotting process, immune responses, and tissue repair. Throughout the complex process of tissue repair, there are intricate interactions among connective tissue cells, epithelial cells, immune system cells, and blood cells.

Primarily, platelets are responsible for the clotting process, aiding in homeostasis through adhesion, activation, and aggregation. When there is a vascular injury, platelet activation occurs, leading to the release of substances from platelet granules that promote coagulation.13 Recent studies have revealed that apart from their hemostatic activities, platelets are abundant in GFs and cytokines, which can influence inflammation, angiogenesis, stem cell migration, and cell proliferation.13,14 In addition to their role as GFs, platelets also act as chemical messengers and play essential roles in various tissue-level processes, including proliferation, differentiation, chemotaxis, and tissue morphogenesis.15

1.3

1.3 Application of PRP in sports medicine and traumatology

Bone, tendon, ligament, and muscle injuries follow a staged healing process. Platelet-rich plasma (PRP) is utilized in the treatment of soft tissue and bone injuries within the musculoskeletal system, particularly in the field of sports medicine. PRP, enriched with growth factors (GFs), is employed due to the frequent occurrence of tendon, ligament, and muscle injuries in sports that require prompt and effective interventions for the speedy recovery of athletes. [Table – 1] describes application of PRP in Sports Medicine and Traumatology.

Common sports injuries such as Achilles tendon injuries, runner's knee, rotator cuff tears, meniscus tears, and cruciate ligament tears are now being treated using PRP.

1.4

1.4 Achilles tendon

Due to increased competitiveness, an aging population, and rising obesity rates, the incidence of Achilles tendon rupture is on the rise.16 Activities such as sports, dancing, or military service increase the likelihood of Achilles tendon disease. The majority of severe Achilles tendon injuries occur as a result of sports activities, and professional athletes are particularly prone to Achilles tendon injuries. Approximately 30–50 out of 100 sports-related injuries involve tendon injuries.17 Sports involving activities like jogging, badminton, squash, or training in subzero weather put individuals at a higher risk of Achilles tendon injury.18,19

A case-control study on athletes showed that compared to conventional repair procedures, there was a quicker return to activity and sports, with a more modest increase in tendon cross-sectional area after 18 months. These findings indicate a less fibrotic healing process in the study population.20 In a randomized controlled study by Schepull et al. where 30 patients with ruptured Achilles tendon underwent surgical repair and were administered 10 ml of PRP, no biomechanical effect on Achilles tendon healing was found.21 Another retrospective study on cases of acute Achilles tendon rupture that underwent surgical repair found nearly complete restoration of walking dynamics in both groups at 6 months, regardless of whether PRP was administered over the suture site. However, the patients who received PRP augmentation showed significant functional gains in ankle motion effectiveness.22 On the contrary, Keene conducted a multicenter randomized placebo-controlled trial involving 113 patients with a ruptured Achilles tendon. These patients received a percutaneous injection of 4 mL of PRP at the center of the tendon gap, preceded by a local anesthetic injection of 1–2 mL into the surrounding skin, without anesthetizing the tendon itself. Despite laboratory studies not supporting the use of PRP for tendon healing, the authors claimed that the positive results from PRP laboratory research did not translate into observable improvements in patient rehabilitation from tendon injury.23,24

The lack of consistency in PRP preparation techniques and application modalities is the biggest weakness in establishing its consistent efficacy. These factors hinder progress and may lead to incorrect assumptions about the effectiveness of PRP treatment. The variability of tendinopathies, activation, administration, rehabilitation procedures, and the type of tendon may all contribute to these contradictory findings.23,25–28

1.5

1.5 Rotator cuff

Rotator cuff tendinopathy is a prevalent and debilitating condition, accounting for nearly half of the cases of shoulder pain worldwide.29,30 It leads to functional impairment, limited range of motion, and difficulty performing overhead tasks, significantly affecting the quality of life for patients.31 Rotator cuff tears are the most common shoulder repair issues, but the success rate for large and catastrophic tears following standard repairs is only about 6–7%.32 Acute rotator cuff tendinopathy is typically caused by direct external force, while chronic rotator cuff tendinopathy may develop over time due to pressure between the acromion and rotator cuff.33,34 Although existing treatment modalities such as physiotherapy, analgesics, and steroid therapy have shown some success, their outcomes vary.35 This is where newer approaches like PRP come into play, as they are believed to accelerate the healing process in various musculoskeletal conditions.36 In 2013, Rha and colleagues conducted a randomized, single-center study to evaluate the effectiveness of PRP injection for treating rotator cuff dysfunction. After a six-month follow-up, the PRP group showed better pain relief and improved freedom of movement. The PRP injection was also found to be safe with no observed negative consequences.37 Scarpone conducted an open-label, prospective study over a four-year and eight-month period, assessing the efficacy of PRP injection using visual analog scale (VAS) scoring and MRI of the rotator cuffs. The study demonstrated significant and long-lasting pain relief in individuals with rotator cuff tendinopathy. However, the study lacked a control group for comparison, and the sample size was small, limiting the ability to predict the response over time.38 Similarly, Tahririan et al. conducted an open-label, prospective trial to evaluate the effectiveness of ultrasound-guided PRP injection for patients with chronic rotator cuff tendinopathy who did not benefit from conservative approaches like physiotherapy. The results showed that PRP improved patients' functional activities and alleviated pain, evaluated using the constant shoulder score (CSS).39

PRP also has the potential to expedite the recovery of rotator cuff conditions. However, when comparing its effectiveness to corticosteroid injections or physical therapy, inconsistent evidence was found. The variation in PRP preparation methods was cited as one of the main reasons for the inability to determine its actual effectiveness and the best treatment option among the three.40

1.6

1.6 Anterior cruciate ligament

Anterior cruciate ligament (ACL) injury is considered one of the most severe orthopedic injuries in sports and can potentially end a career.41 The current standard treatment for ACL injuries in active individuals with knee instability is ACL reconstruction (ACLR).42 However, even though athletes who undergo ACLR generally report good knee function, only 50 % of them are able to return to their previous performance level, and there is a risk of re-tearing the ACL. The recovery process also requires a significant amount of time.43,44

Several studies have supported the use of PRP in the treatment of ACL injuries. Animal studies have shown that PRP can accelerate ACL recovery.45 A study by Mahdi, conducted at a 3-month follow-up after ACLR, demonstrated that PRP was a reliable technique that improved the integration of the graft with the bone.46 Walters found that patients who underwent ACLR, regardless of whether they received PRP or not, had similar levels of kneeling discomfort and patellar defect diameters.47 Furthermore, Sözkesen et al. did not recommend the routine use of PRP to prevent tunnel growth after ACLR.48

PRP also shown efficacy in treating various musculoskeletal conditions such as tennis elbow, golf elbow, abductor muscle enthesopathy, jumper's knee, and runner's knee.49–55 In tennis elbow, PRP injections have demonstrated pain relief, improved grip strength, and enhanced function. Similarly, PRP has been found valuable in treating golf elbow, alleviating symptoms and expediting recovery. PRP also improves symptoms, function, and healing in abductor muscle enthesopathy by repairing the tendon-bone interface. Additionally, PRP therapy has shown positive outcomes in jumper's knee and runner's knee, reducing pain and enhancing functional recovery by promoting tissue regeneration in damaged tendons and cartilage. The regenerative properties of PRP make it a promising treatment modality in sports medicine for enhancing tissue healing and promoting recovery in these musculoskeletal conditions.

2

2 Conclusion

In conclusion, platelet-rich plasma (PRP) has shown great promise as a treatment modality for sports injuries. Its regenerative properties and ability to promote tissue healing have made it a valuable option for conditions such as tendon and ligament injuries commonly encountered in sports, including Achilles tendon rupture, rotator cuff tears, and anterior cruciate ligament (ACL) injuries. PRP has also demonstrated effectiveness in managing specific sports-related conditions like tennis elbow, golf elbow, jumper's knee, and runner's knee. While further research is needed to optimize PRP protocols and understand its mechanisms of action in sports injuries, it holds significant potential for enhancing the recovery and rehabilitation of athletes, ultimately contributing to improved outcomes in the field of sports medicine.

Authors contribution

PP - Idea, conceptualization, writing draft, approved final draft. MJ – writing draft and revision of draft, approved final draft. TKS – Supervision, Project Administration, writing draft and revision of draft, approved final draft. VT - writing draft and revision of draft, approved final draft.

Ethics approval and consent to participate

Not Applicable.

Consent for publication

Not Applicable.

Funding

None.

Ethical approval

Not Required.

Data availability

Not Applicable.

References

  1. , , , et al . Is platelet-rich plasma an ideal biomaterial for arthroscopic rotator cuff repair? A systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res. 2019 Jun 20;14(1):183.
    [Google Scholar]
  2. , , , et al . Platelet-rich plasma, a source of autologous growth factors and biomimetic scaffold for peripheral nerve regeneration. Expet Opin Biol Ther. 2017 Feb;17(2):197-212.
    [Google Scholar]
  3. , , . Principles and methods of preparation of platelet-rich plasma: a review and author's perspective. J Cutan Aesthetic Surg. 2014 Oct-Dec;7(4):189-197.
    [Google Scholar]
  4. , , , et al . Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med. 2008 Jun;36(6):1171-1178.
    [Google Scholar]
  5. , . Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent. 2001;10(4):225-228.
    [Google Scholar]
  6. , , , et al . Efficacy of platelet-rich plasma as an adjuvant to surgical carpal ligament release: a prospective, randomized controlled clinical trial. Sci Rep. 2020 Feb 7;10(1):2085.
    [Google Scholar]
  7. , , . Applications of platelet-rich plasma in dermatology: a critical appraisal of the literature. J Dermatol Treat. 2016;27(3):285-289.
    [Google Scholar]
  8. , , . Overview of blood components and their preparation. Indian J Anaesth. 2014 Sep;58(5):529-537.
    [Google Scholar]
  9. , , , . The use of autologous platelet-rich plasma (platelet gel) and autologous platelet-poor plasma (fibrin glue) in cosmetic surgery. Plast Reconstr Surg. 2001 Jan;107(1):229-237.
    [Google Scholar]
  10. , , , et al . The effect of the platelet concentration in platelet-rich plasma gel on the regeneration of bone. J Bone Joint Surg Br. 2008 Jul;90(7):966-972.
    [Google Scholar]
  11. , , , et al . Platelet-rich plasma: current concepts and application in sports medicine. J Am Acad Orthop Surg. 2009 Oct;17(10):602-608.
    [Google Scholar]
  12. , , . A review of platelet-rich plasma: history, biology, mechanism of action, and classification. Skin Appendage Disord. 2018 Jan;4(1):18-24.
    [Google Scholar]
  13. , , . The pathophysiology and consequences of red blood cell storage. Anaesthesia. 2015 Jan;70(Suppl 1):29-37.
    [Google Scholar]
  14. , , , et al . Autologous platelet-rich plasma for nonhealing ulcers: a comparative study. Vasc Specialist Int. 2019 Mar;35(1):22-27.
    [Google Scholar]
  15. , , , et al . Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010 Jan 13;303(2):144-149.
    [Google Scholar]
  16. , , , et al . Treatment of acute achilles tendon rupture. Clin Orthop Surg. 2020 Mar;12(1):1-8.
    [Google Scholar]
  17. , , . Tendon injury and tendinopathy: healing and repair. J Bone Joint Surg Am. 2005 Jan;87(1):187-202.
    [Google Scholar]
  18. , , , et al . Cold weather training: a risk factor for Achilles paratendinitis among recruits. Foot Ankle Int. 2003 May;24(5):398-401.
    [Google Scholar]
  19. , , , . Painful conditions in the Achilles tendon region: a common problem in middle-aged competitive badminton players. Knee Surg Sports Traumatol Arthrosc. 2002 Jan;10(1):57-60.
    [Google Scholar]
  20. , , , et al . Comparison of surgically repaired Achilles tendon tears using platelet-rich fibrin matrices. Am J Sports Med. 2007 Feb;35(2):245-251.
    [Google Scholar]
  21. , , , et al . Autologous platelets have no effect on the healing of human achilles tendon ruptures: a randomized single-blind study. Am J Sports Med. 2011 Jan;39(1):38-47.
    [Google Scholar]
  22. , , , et al . Achilles tendon open surgical treatment with platelet-rich fibrin matrix augmentation: biomechanical evaluation. J Foot Ankle Surg. 2017 May-Jun;56(3):581-585.
    [Google Scholar]
  23. , , , et al . Platelet rich plasma injection for acute Achilles tendon rupture: PATH-2 randomised, placebo controlled, superiority trial. BMJ. 2019 Nov 20;367:l6132.
    [Google Scholar]
  24. , , , et al . The differential effects of leukocyte-containing and pure platelet-rich plasma (PRP) on tendon stem/progenitor cells - implications of PRP application for the clinical treatment of tendon injuries. Stem Cell Res Ther. 2015 Sep 15;6(1):173.
    [Google Scholar]
  25. , , , et al . Does platelet-rich plasma deserve a role in the treatment of tendinopathy? Joint Bone Spine. 2015 Jul;82(4):230-234.
    [Google Scholar]
  26. , , , et al . Autologous fibrin scaffolds: when platelet- and plasma-derived biomolecules meet fibrin. Biomaterials. 2019 Feb;192:440-460.
    [Google Scholar]
  27. , , , . Platelet-rich plasma: the PAW classification system. Arthroscopy. 2012 Jul;28(7):998-1009.
    [Google Scholar]
  28. , , , et al . Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part II: treatment options. J Exp Orthop. 2018 Sep 24;5(1):38.
    [Google Scholar]
  29. , , , et al . Impingement syndrome of the shoulder. Dtsch Arztebl Int. 2017 Nov 10;114(45):765-776.
    [Google Scholar]
  30. , , , et al . Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81.
    [Google Scholar]
  31. , , , et al . Current trends in tendinopathy: consensus of the ESSKA basic science committee. Part I: biology, biomechanics, anatomy and an exercise-based approach. J Exp Orthop. 2017 Dec;4(1):18.
    [Google Scholar]
  32. , , , et al . Rotator cuff repair: published evidence on factors associated with repair integrity and clinical outcome. Am J Sports Med. 2015 Feb;43(2):491-500.
    [Google Scholar]
  33. , , , et al . Management of rotator cuff injuries in the elite athlete. Curr Rev Musculoskelet Med. 2018 Mar;11(1):102-112.
    [Google Scholar]
  34. , , . Current concepts of rotator cuff tendinopathy. Int J Sports Phys Ther. 2014 Apr;9(2):274-288.
    [Google Scholar]
  35. , , , . Role of platelet rich plasma in rotator cuff tendinopathy- clinical application and review of literature. J Clin Orthop Trauma. 2019 Mar-Apr;10(2):244-247.
    [Google Scholar]
  36. , , , et al . Platelet-rich plasma: review of current literature on its use for tendon and ligament pathology. Curr Rev Musculoskelet Med. 2018 Dec;11(4):566-572.
    [Google Scholar]
  37. , , , et al . Comparison of the therapeutic effects of ultrasound-guided platelet-rich plasma injection and dry needling in rotator cuff disease: a randomized controlled trial. Clin Rehabil. 2013 Feb;27(2):113-122.
    [Google Scholar]
  38. , , , et al . Effectiveness of platelet-rich plasma injection for rotator cuff tendinopathy: a prospective open-label study. Glob Adv Health Med. 2013 Mar;2(2):26-31.
    [Google Scholar]
  39. , , , et al . Ultrasound guided platelet-rich plasma injection for the treatment of rotator cuff tendinopathy. Adv Biomed Res. 2016 Dec 27;5:200.
    [Google Scholar]
  40. , , . Platelet-rich plasma for rotator cuff tendinopathy: a systematic review and meta-analysis. PLoS One. 2021 May 10;16(5)
    [Google Scholar]
  41. , , , , . Psychological readiness to return to sport is associated with second anterior cruciate ligament injuries. Am J Sports Med. 2019 Mar;47(4):857-862.
    [Google Scholar]
  42. , , . Clinical outcomes, return to sports, and patient satisfaction after anterior cruciate ligament reconstruction in young and middle-aged patients in an asian population-A 2-year follow-up study. Arthroscopy. 2018 Apr;34(4):1054-1059.
    [Google Scholar]
  43. , , , et al . Return to play and long-term participation in pivoting sports after anterior cruciate ligament reconstruction. Am J Sports Med. 2019 Dec;47(14):3339-3346.
    [Google Scholar]
  44. , , , et al . Incidence of second anterior cruciate ligament tears (1990-2000) and associated factors in a specific geographic locale. Am J Sports Med. 2017 Jun;45(7):1567-1573.
    [Google Scholar]
  45. , , , et al . Acute management of anterior cruciate ligament injuries using novel canine models. J Knee Surg. 2016 Oct;29(7):594-603.
    [Google Scholar]
  46. , , , et al . Effects of platelet-rich plasma on clinical outcomes after anterior cruciate ligament reconstruction: a systematic review and meta-analysis. Orthop J Sports Med. 2022 Jan 31;10(1)
    [Google Scholar]
  47. , , , et al . Effect of intraoperative platelet-rich plasma treatment on postoperative donor site knee pain in patellar tendon autograft anterior cruciate ligament reconstruction: a double-blind randomized controlled trial. Am J Sports Med. 2018 Jul;46(8):1827-1835.
    [Google Scholar]
  48. , , , et al . PRP on preventıon of tunnel enlargement in ACL reconstructıon. Ortop Traumatol Rehabil. 2018 Aug 30;20(4):285-291.
    [Google Scholar]
  49. , , , et al . Treatment of muscle injuries by local administration of autologous conditioned serum: a pilot study on sportsmen with muscle strains. Int J Sports Med. 2004 Nov;25(8):588-593.
    [Google Scholar]
  50. , . The chronic painful Achilles and patellar tendon: research on basic biology and treatment. Scand J Med Sci Sports. 2005 Aug;15(4):252-259.
    [Google Scholar]
  51. , , , et al . Use of autologous platelet-rich plasma to treat muscle strain injuries. Am J Sports Med. 2009 Jun;37(6):1135-1142.
    [Google Scholar]
  52. , , , et al . Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010 Feb;38(2):255-262.
    [Google Scholar]
  53. , , , et al . Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med. 2011 Sep;45(12):966-971.
    [Google Scholar]
  54. , , , et al . Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472-479.
    [Google Scholar]
  55. , , , . Classification of platelet concentrates: from pure platelet-rich plasma (P-PRP) to leucocyte- and platelet-rich fibrin (L-PRF) Trends Biotechnol. 2009 Mar;27(3):158-167.
    [Google Scholar]

Fulltext Views
39

PDF downloads
0
View/Download PDF
Download Citations
BibTeX
RIS
Show Sections

Suggested read for related articles: