Platelet-rich Plasma in the Pathologic Processes of Tendinopathy: a Review of Basic Science Studies

Overview

Journal Front Bioeng Biotechnol

Date 2023 Aug 7

PMID 37545895

Authors

Jialin Lu

Han Li

Ziyu Zhang

Rui Xu

Jincheng Wang

Hui Jin

Affiliations

Soon will be listed here.

Abstract

Tendinopathy is a medical condition that includes a spectrum of inflammatory and degenerative tendon changes caused by traumatic or overuse injuries. The pathological mechanism of tendinopathy has not been well defined, and no ideal treatment is currently available. Platelet-rich plasma (PRP) is an autologous whole blood derivative containing a variety of cytokines and other protein components. Various basic studies have found that PRP has the therapeutic potential to promote cell proliferation and differentiation, regulate angiogenesis, increase extracellular matrix synthesis, and modulate inflammation in degenerative tendons. Therefore, PRP has been widely used as a promising therapeutic agent for tendinopathy. However, controversies exist over the optimal treatment regimen and efficacy of PRP for tendinopathy. This review focuses on the specific molecular and cellular mechanisms by which PRP manipulates tendon healing to better understand how PRP affects tendinopathy and explore the reason for the differences in clinical trial outcomes. This article has also pointed out the future direction of basic research and clinical application of PRP in the treatment of tendinopathy, which will play a guiding role in the design of PRP treatment protocols for tendinopathy.

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References

Chan B, Chan K, Maffulli N, Webb S, Lee K . Effect of basic fibroblast growth factor. An in vitro study of tendon healing. Clin Orthop Relat Res. 1997; (342):239-47. View

Saltzman B, Jain A, Campbell K, Mascarenhas R, Romeo A, Verma N . Does the Use of Platelet-Rich Plasma at the Time of Surgery Improve Clinical Outcomes in Arthroscopic Rotator Cuff Repair When Compared With Control Cohorts? A Systematic Review of Meta-analyses. Arthroscopy. 2016; 32(5):906-18. DOI: 10.1016/j.arthro.2015.10.007. View

Del Buono A, Battery L, Denaro V, Maccauro G, Maffulli N . Tendinopathy and inflammation: some truths. Int J Immunopathol Pharmacol. 2011; 24(1 Suppl 2):45-50. DOI: 10.1177/03946320110241S209. View

de Vos R, Weir A, van Schie H, Bierma-Zeinstra S, Verhaar J, Weinans H . Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010; 303(2):144-9. DOI: 10.1001/jama.2009.1986. View

Li H, Hua Y . Achilles Tendinopathy: Current Concepts about the Basic Science and Clinical Treatments. Biomed Res Int. 2016; 2016:6492597. PMC: 5112330. DOI: 10.1155/2016/6492597. View

Fleming B, Spindler K, Palmer M, Magarian E, Murray M . Collagen-platelet composites improve the biomechanical properties of healing anterior cruciate ligament grafts in a porcine model. Am J Sports Med. 2009; 37(8):1554-63. PMC: 2796133. DOI: 10.1177/0363546509332257. View

Dakin S, Dudhia J, Smith R . Resolving an inflammatory concept: the importance of inflammation and resolution in tendinopathy. Vet Immunol Immunopathol. 2014; 158(3-4):121-7. PMC: 3991845. DOI: 10.1016/j.vetimm.2014.01.007. View

Dakin S, Werling D, Hibbert A, Abayasekara D, Young N, Whealands Smith R . Macrophage sub-populations and the lipoxin A4 receptor implicate active inflammation during equine tendon repair. PLoS One. 2012; 7(2):e32333. PMC: 3284560. DOI: 10.1371/journal.pone.0032333. View

Rodeo S . The Need for Minimum Reporting Standards for Studies of "Biologics" in Sports Medicine. Am J Sports Med. 2019; 47(11):2531-2532. DOI: 10.1177/0363546519872219. View

10.

Thorpe C, Birch H, Clegg P, Screen H . The role of the non-collagenous matrix in tendon function. Int J Exp Pathol. 2013; 94(4):248-59. PMC: 3721456. DOI: 10.1111/iep.12027. View

11.

Dallaudiere B, Zurlinden O, Perozziello A, Deschamps L, Larbi A, Louedec L . Combined intra-tendinous injection of Platelet Rich Plasma and bevacizumab accelerates and improves healing compared to Platelet Rich Plasma in tendinosis: comprehensive assessment on a rat model. Muscles Ligaments Tendons J. 2014; 4(3):351-6. PMC: 4241427. View

12.

Lin C, Huang S, Tzou S, Yin C, Chen J, Chen Y . Tendon Disorders in Chronic Liver Disease: A Retrospective Cohort Study in Taiwan. Int J Environ Res Public Health. 2023; 20(6). PMC: 10049230. DOI: 10.3390/ijerph20064983. View

13.

Lipman K, Wang C, Ting K, Soo C, Zheng Z . Tendinopathy: injury, repair, and current exploration. Drug Des Devel Ther. 2018; 12:591-603. PMC: 5865563. DOI: 10.2147/DDDT.S154660. View

14.

Nourissat G, Ornetti P, Berenbaum F, Sellam J, Richette P, Chevalier X . Does platelet-rich plasma deserve a role in the treatment of tendinopathy?. Joint Bone Spine. 2015; 82(4):230-4. DOI: 10.1016/j.jbspin.2015.02.004. View

15.

Tang C, Chen Y, Huang J, Zhao K, Chen X, Yin Z . The roles of inflammatory mediators and immunocytes in tendinopathy. J Orthop Translat. 2018; 14:23-33. PMC: 6034108. DOI: 10.1016/j.jot.2018.03.003. View

16.

Witt B, Hyer C . Achilles tendon reattachment after surgical treatment of insertional tendinosis using the suture bridge technique: a case series. J Foot Ankle Surg. 2012; 51(4):487-93. DOI: 10.1053/j.jfas.2012.03.006. View

17.

Fukawa T, Yamaguchi S, Watanabe A, Sasho T, Akagi R, Muramatsu Y . Quantitative Assessment of Tendon Healing by Using MR T2 Mapping in a Rabbit Achilles Tendon Transection Model Treated with Platelet-rich Plasma. Radiology. 2015; 276(3):748-55. DOI: 10.1148/radiol.2015141544. View

18.

Titan A, Foster D, Chang J, Longaker M . Flexor Tendon: Development, Healing, Adhesion Formation, and Contributing Growth Factors. Plast Reconstr Surg. 2019; 144(4):639e-647e. PMC: 7092377. DOI: 10.1097/PRS.0000000000006048. View

19.

Nishio H, Saita Y, Kobayashi Y, Takaku T, Fukusato S, Uchino S . Platelet-rich plasma promotes recruitment of macrophages in the process of tendon healing. Regen Ther. 2020; 14:262-270. PMC: 7232040. DOI: 10.1016/j.reth.2020.03.009. View

20.

Liu X, Zhu B, Li Y, Liu X, Guo S, Wang C . The Role of Vascular Endothelial Growth Factor in Tendon Healing. Front Physiol. 2021; 12:766080. PMC: 8579915. DOI: 10.3389/fphys.2021.766080. View