Skip to main content
SpringerLink
Log in

Does Platelet-Rich Plasma Increase Tendon Metabolism?

  • Chapter
  • First Online:
Metabolic Influences on Risk for Tendon Disorders

Part of the book series: Advances in Experimental Medicine and Biology ((AEMB,volume 920))

Abstract

Acute and overuse tendon disorders are frequently observed in the middle-aged active population. Tendon overuse injuries are currently designated as “tendinopathy”. Histopathological studies have shown that chronic tendinopathy is frequently characterised by degenerative changes, such as decreased organisation of collagen, altered cell distribution and neovascularisation. In the recent years, scientific research and technology in the field of regenerative medicine has provided a new perspectives on managing chronic tendinopathy. An initiation of tissue healing can be attempted by local delivery of growth factors. Nowadays, platelet-rich plasma (PRP) is a commonly applied approach to achieve this. Platelet degranulation leads to a release of various growth factors and cytokines. There is a classification system to define the different forms of PRP. In the past decade, a number of studies have been published on the effects of PRP in different basic science studies. These studies suggest that PRP modulates some aspects of tendon metabolic activity. This is one of the reasons why PRP is increasingly used by many clinicians as treatment option for tendinopathy in daily clinical practice. There is, however, evidence from the literature that it does not lead to improved outcome on imaging findings and on patient-reported outcomes. This questions the role of PRP injections as regular treatment for tendinopathy. Moreover, it results in a broader discussion on the required effects that need to occur for tendon healing and symptom relieve.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 129.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 169.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Abbreviations

PRP:

platelet-rich plasma

PPP:

platelet-poor plasma

P-PRP:

pure platelet-rich plasma

L-PRP:

leukocyte- and platelet-rich plasma

P-PRF:

pure platelet-rich fibrin

L-PRF:

leukocyte- and platelet-rich fibrin

PDGF:

platelet-derived growth factor

TGF-β:

transforming growth factor-β

VEGF:

vascular-derived endothelial growth factor

EGF:

epithelial growth factor

HGF:

hepatocyte growth factor

IGF:

insulin-like growth factor

MMPs:

matrix metalloproteinases

ELISA:

enzyme-linked immunology assay

US:

ultrasonography

MRI:

magnetic resonance imaging

References

  1. Maffulli N, Wong J, Almekinders LC (2003) Types and epidemiology of tendinopathy. Clin Sports Med 22(4):675–692

    Article  PubMed  Google Scholar 

  2. Nielsen RO, Parner ET, Nohr EA, So H, Lind M, Rasmussen S (2014) Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. J Orthop Sports Phys Ther 44(10):739–747

    Article  PubMed  Google Scholar 

  3. Ackermann PW, Renstrom P (2012) Tendinopathy in sport. Sports Health 4(3):193–201

    Article  PubMed  PubMed Central  Google Scholar 

  4. Alfredson H (2003) Chronic midportion Achilles tendinopathy: an update on research and treatment. Clin Sports Med 22(4):727–741

    Article  PubMed  Google Scholar 

  5. de Mos M, van El B, DeGroot J, Jahr H, van Schie HT, van Arkel ER et al (2007) Achilles tendinosis: changes in biochemical composition and collagen turnover rate. Am J Sports Med 35(9):1549–1556

    Article  PubMed  Google Scholar 

  6. Maffulli N, Barrass V, Ewen SW (2000) Light microscopic histology of achilles tendon ruptures. A comparison with unruptured tendons. Am J Sports Med 28(6):857–863

    CAS  PubMed  Google Scholar 

  7. Mishra A, Harmon K, Woodall J, Vieira A (2012) Sports medicine applications of platelet rich plasma. Curr Pharm Biotechnol 13(7):1185–1195

    Article  CAS  PubMed  Google Scholar 

  8. de Vos RJ, van Veldhoven PL, Moen MH, Weir A, Tol JL, Maffulli N (2010) Autologous growth factor injections in chronic tendinopathy: a systematic review. Br Med Bull 95:63–77

    Article  PubMed  Google Scholar 

  9. Sampson S, Gerhardt M, Mandelbaum B (2008) Platelet rich plasma injection grafts for musculoskeletal injuries: a review. Curr Rev Musculoskelet Med 1(3–4):165–174

    Article  PubMed  PubMed Central  Google Scholar 

  10. Eppley BL, Woodell JE, Higgins J (2004) Platelet quantification and growth factor analysis from platelet-rich plasma: implications for wound healing. Plast Reconstr Surg 114(6):1502–1508

    Article  PubMed  Google Scholar 

  11. Eppley BL, Pietrzak WS, Blanton M (2006) Platelet-rich plasma: a review of biology and applications in plastic surgery. Plast Reconstr Surg 118(6):147e-59e

    Article  Google Scholar 

  12. Fufa D, Shealy B, Jacobson M, Kevy S, Murray MM (2008) Activation of platelet-rich plasma using soluble type I collagen. J Oral Maxillofac Surg 66(4):684–690

    Article  PubMed  PubMed Central  Google Scholar 

  13. Marx RE (2001) Platelet-rich plasma (PRP): what is PRP and what is not PRP? Implant Dent 10(4):225–228

    Article  CAS  PubMed  Google Scholar 

  14. Dohan Ehrenfest DM, Andia I, Zumstein MA, Zhang CQ, Pinto NR, Bielecki T (2014) Classification of platelet concentrates (Platelet-Rich Plasma-PRP, Platelet-Rich Fibrin-PRF) for topical and infiltrative use in orthopedic and sports medicine: current consensus, clinical implications and perspectives. Muscles Ligaments Tendons J 4(1):3–9

    PubMed  PubMed Central  Google Scholar 

  15. Anitua E, Andia I, Sanchez M, Azofra J, del Mar Zalduendo M, de la Fuente M et al (2005) Autologous preparations rich in growth factors promote proliferation and induce VEGF and HGF production by human tendon cells in culture. J Orthop Res 23(2):281–286

    Article  CAS  PubMed  Google Scholar 

  16. Baksh N, Hannon CP, Murawski CD, Smyth NA, Kennedy JG (2013) Platelet-rich plasma in tendon models: a systematic review of basic science literature. Arthroscopy 29(3):596–607

    Article  PubMed  Google Scholar 

  17. Jo CH, Kim JE, Yoon KS, Shin S (2012) Platelet-rich plasma stimulates cell proliferation and enhances matrix gene expression and synthesis in tenocytes from human rotator cuff tendons with degenerative tears. Am J Sports Med 40(5):1035–1045

    Article  PubMed  Google Scholar 

  18. de Mos M, van der Windt AE, Jahr H, van Schie HT, Weinans H, Verhaar JA et al (2008) Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med 36(6):1171–1178

    Article  PubMed  Google Scholar 

  19. Parafioriti A, Armiraglio E, Del Bianco S, Tibalt E, Oliva F, Berardi AC (2011) Single injection of platelet-rich plasma in a rat Achilles tendon tear model. Muscles Ligaments Tendons J 1(2):41–47

    PubMed  PubMed Central  Google Scholar 

  20. Lyras D, Kazakos K, Verettas D, Polychronidis A, Simopoulos C, Botaitis S et al (2010) Immunohistochemical study of angiogenesis after local administration of platelet-rich plasma in a patellar tendon defect. Int Orthop 34(1):143–148

    Article  PubMed  Google Scholar 

  21. Bosch G, van Schie HT, de Groot MW, Cadby JA, van de Lest CH, Barneveld A et al (2010) Effects of platelet-rich plasma on the quality of repair of mechanically induced core lesions in equine superficial digital flexor tendons: a placebo-controlled experimental study. J Orthop Res 28(2):211–217

    CAS  PubMed  Google Scholar 

  22. Fernandez-Sarmiento JA, Dominguez JM, Granados MM, Morgaz J, Navarrete R, Carrillo JM et al (2013) Histological study of the influence of plasma rich in growth factors (PRGF) on the healing of divided Achilles tendons in sheep. J Bone Joint Surg Am 95(3):246–255

    Article  PubMed  Google Scholar 

  23. Dolkart O, Chechik O, Zarfati Y, Brosh T, Alhajajra F, Maman E (2014) A single dose of platelet-rich plasma improves the organization and strength of a surgically repaired rotator cuff tendon in rats. Arch Orthop Trauma Surg 134(9):1271–1277

    Article  PubMed  Google Scholar 

  24. McCarrel T, Fortier L (2009) Temporal growth factor release from platelet-rich plasma, trehalose lyophilized platelets, and bone marrow aspirate and their effect on tendon and ligament gene expression. J Orthop Res 27(8):1033–1042

    Article  CAS  PubMed  Google Scholar 

  25. Zhang J, Wang JH (2010) Platelet-rich plasma releasate promotes differentiation of tendon stem cells into active tenocytes. Am J Sports Med 38(12):2477–2486

    Article  PubMed  Google Scholar 

  26. Lyras DN, Kazakos K, Verettas D, Botaitis S, Agrogiannis G, Kokka A et al (2009) The effect of platelet-rich plasma gel in the early phase of patellar tendon healing. Arch Orthop Trauma Surg 129(11):1577–1582

    Article  PubMed  Google Scholar 

  27. Spang JT, Tischer T, Salzmann GM, Winkler T, Burgkart R, Wexel G et al (2011) Platelet concentrate vs. saline in a rat patellar tendon healing model. Knee Surg Sports Traumatol Arthrosc 19(3):495–502

    Article  PubMed  Google Scholar 

  28. Virchenko O, Aspenberg P (2006) How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks? Interplay between early regeneration and mechanical stimulation. Acta Orthop 77(5):806–812

    Article  PubMed  Google Scholar 

  29. Chen L, Dong SW, Liu JP, Tao X, Tang KL, Xu JZ (2012) Synergy of tendon stem cells and platelet-rich plasma in tendon healing. J Orthop Res 30(6):991–997

    Article  CAS  PubMed  Google Scholar 

  30. McCarrel TM, Minas T, Fortier LA (2012) Optimization of leukocyte concentration in platelet-rich plasma for the treatment of tendinopathy. J Bone Joint Surg Am 94(19):e143(1–8)

    Article  Google Scholar 

  31. Dragoo JL, Braun HJ, Durham JL, Ridley BA, Odegaard JI, Luong R et al (2012) Comparison of the acute inflammatory response of two commercial platelet-rich plasma systems in healthy rabbit tendons. Am J Sports Med 40(6):1274–1281

    Article  PubMed  Google Scholar 

  32. Boswell SG, Schnabel LV, Mohammed HO, Sundman EA, Minas T, Fortier LA (2014) Increasing platelet concentrations in leukocyte-reduced platelet-rich plasma decrease collagen gene synthesis in tendons. Am J Sports Med 42(1):42–49

    Article  PubMed  Google Scholar 

  33. Zhang J, Middleton KK, Fu FH, Im HJ, Wang JH (2013) HGF mediates the anti-inflammatory effects of PRP on injured tendons. PLoS One 8(6):e67303

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Kajikawa Y, Morihara T, Sakamoto H, Matsuda K, Oshima Y, Yoshida A et al (2008) Platelet-rich plasma enhances the initial mobilization of circulation-derived cells for tendon healing. J Cell Physiol 215(3):837–845

    Article  CAS  PubMed  Google Scholar 

  35. Wasterlain AS, Braun HJ, Harris AH, Kim HJ, Dragoo JL (2013) The systemic effects of platelet-rich plasma injection. Am J Sports Med 41(1):186–193

    Article  PubMed  Google Scholar 

  36. Dallaudiere B, Louedec L, Lenet MP, Pesquer L, Blaise E, Perozziello A et al (2015) The molecular systemic and local effects of intra-tendinous injection of Platelet Rich Plasma in tendinosis: preliminary results on a rat model with ELISA method. Muscles Ligaments Tendons J 5(2):99–105

    PubMed  PubMed Central  Google Scholar 

  37. de Vos RJ, d’Hooghe PPRN, de Leeuw P, Kerkhoffs GMMJ (2014) Chapter 19: Achilles Tendinopathy. In: d’Hooghe PPRN, Kerkhoffs GMMJ (eds) The ankle in football, sports and traumatology. Springer Verlag, Paris, pp 213–233

    Google Scholar 

  38. van Schie HT, de Vos RJ, de Jonge S, Bakker EM, Heijboer MP, Verhaar JA et al (2010) Ultrasonographic tissue characterisation of human Achilles tendons: quantification of tendon structure through a novel non-invasive approach. Br J Sports Med 44(16):1153–1159

    Article  PubMed  Google Scholar 

  39. Sengkerij PM, de Vos RJ, Weir A, van Weelde BJ, Tol JL (2009) Interobserver reliability of neovascularization score using power Doppler ultrasonography in midportion achilles tendinopathy. Am J Sports Med 37(8):1627–1631

    Article  PubMed  Google Scholar 

  40. de Vos RJ, Weir A, Cobben LP, Tol JL (2007) The value of power Doppler ultrasonography in Achilles tendinopathy: a prospective study. Am J Sports Med 35(10):1696–1701

    Article  PubMed  Google Scholar 

  41. Bleakney RR, White LM (2005) Imaging of the Achilles tendon. Foot Ankle Clin 10(2):239–254

    Article  PubMed  Google Scholar 

  42. Gaweda K, Tarczynska M, Krzyzanowski W (2010) Treatment of Achilles tendinopathy with platelet-rich plasma. Int J Sports Med 31(8):577–583

    Article  CAS  PubMed  Google Scholar 

  43. Monto RR (2012) Platelet rich plasma treatment for chronic Achilles tendinosis. Foot Ankle Int 33(5):379–385

    Article  PubMed  Google Scholar 

  44. Filardo G, Kon E, Di Matteo B, Pelotti P, Di Martino A, Marcacci M (2013) Platelet-rich plasma for the treatment of patellar tendinopathy: clinical and imaging findings at medium-term follow-up. Int Orthop 37(8):1583–1589

    Article  PubMed  PubMed Central  Google Scholar 

  45. Oloff L, Elmi E, Nelson J, Crain J (2015) Retrospective analysis of the effectiveness of platelet-rich plasma in the treatment of Achilles tendinopathy: pretreatment and posttreatment correlation of magnetic resonance imaging and clinical assessment. Foot Ankle Spec 8:490–497

    Article  PubMed  Google Scholar 

  46. Owens RF Jr, Ginnetti J, Conti SF, Latona C (2011) Clinical and magnetic resonance imaging outcomes following platelet rich plasma injection for chronic midsubstance Achilles tendinopathy. Foot Ankle Int 32(11):1032–1039

    Article  PubMed  Google Scholar 

  47. de Vos RJ, Weir A, Tol JL, Verhaar JA, Weinans H, van Schie HT (2011) No effects of PRP on ultrasonographic tendon structure and neovascularisation in chronic midportion Achilles tendinopathy. Br J Sports Med 45(5):387–392

    Article  PubMed  Google Scholar 

  48. de Vos RJ (2014) Is tendon structure associated with symptoms in chronic Achilles tendinopathy? An update on tendon pain mechanisms. Aspetar Sports Med J 3(4):594–600

    Google Scholar 

  49. de Vos RJ, Heijboer MP, Weinans H, Verhaar JA, van Schie JT (2012) Tendon structure’s lack of relation to clinical outcome after eccentric exercises in chronic midportion Achilles tendinopathy. J Sport Rehabil 21(1):34–43

    Article  PubMed  Google Scholar 

  50. de Jonge S, Warnaars JL, De Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM et al (2013) Relationship between neovascularization and clinical severity in Achilles tendinopathy in 556 paired measurements. Scand J Med Sci Sports 24:773–778

    Article  PubMed  Google Scholar 

  51. de Vos RJ, Windt J, Weir A (2014) Strong evidence against platelet-rich plasma injections for chronic lateral epicondylar tendinopathy: a systematic review. Br J Sports Med 48(12):952–956

    Article  PubMed  Google Scholar 

  52. Mishra A, Woodall J Jr, Vieira A (2009) Treatment of tendon and muscle using platelet-rich plasma. Clin Sports Med 28(1):113–125

    Article  PubMed  Google Scholar 

  53. Mishra A, Pavelko T (2006) Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med 34(11):1774–1778

    Article  PubMed  Google Scholar 

  54. Kon E, Filardo G, Delcogliano M, Presti ML, Russo A, Bondi A et al (2009) Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper’s knee. Injury 40(6):598–603

    Article  PubMed  Google Scholar 

  55. Paoloni J, De Vos RJ, Hamilton B, Murrell GA, Orchard J (2011) Platelet-rich plasma treatment for ligament and tendon injuries. Clin J Sport Med 21(1):37–45

    Article  PubMed  Google Scholar 

  56. de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H et al (2010) Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA 303(2):144–149

    Article  PubMed  Google Scholar 

  57. de Jonge S, de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA et al (2011) One-year follow-up of platelet-rich plasma treatment in chronic Achilles tendinopathy: a double-blind randomized placebo-controlled trial. Am J Sports Med 39(8):1623–1629

    Article  PubMed  Google Scholar 

  58. Kearney RS, Parsons N, Costa ML (2013) Achilles tendinopathy management: a pilot randomised controlled trial comparing platelet-richplasma injection with an eccentric loading programme. Bone Joint Res 2(10):227–232

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Thanasas C, Papadimitriou G, Charalambidis C, Paraskevopoulos I, Papanikolaou A (2011) Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: a randomized controlled clinical trial. Am J Sports Med 39(10):2130–2134

    Article  PubMed  Google Scholar 

  60. Creaney L, Wallace A, Curtis M, Connell D (2011) 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 45(12):966–971

    Article  PubMed  Google Scholar 

  61. Ruiz-Moneo P, Molano-Munoz J, Prieto E, Algorta J (2013) Plasma rich in growth factors in arthroscopic rotator cuff repair: a randomized, double-blind, controlled clinical trial. Arthroscopy 29(1):2–9

    Article  PubMed  Google Scholar 

  62. Rodeo SA, Delos D, Williams RJ, Adler RS, Pearle A, Warren RF (2012) The effect of platelet-rich fibrin matrix on rotator cuff tendon healing: a prospective, randomized clinical study. Am J Sports Med 40(6):1234–1241

    Article  PubMed  Google Scholar 

  63. Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T (2010) 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 38(2):255–262

    Article  PubMed  Google Scholar 

  64. Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA et al (2014) Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med 42(2):463–471

    Article  PubMed  Google Scholar 

  65. Scarpone M, Rabago D, Snell E, Demeo P, Ruppert K, Pritchard P et al (2013) Effectiveness of platelet-rich plasma injection for Rotator Cuff tendinopathy: a prospective open-label study. Glob Adv Health Med 2(2):26–31

    Article  PubMed  PubMed Central  Google Scholar 

  66. de Vos RJ, Weir A, Brasher PM, Khan KM (2014) Platelet-rich plasma for chronic tennis elbow: letters to the editor. Am J Sports Med 42(1):NP3–NP5

    PubMed  Google Scholar 

  67. Coombes BK, Bisset L, Vicenzino B (2010) Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet 376(9754):1751–1767

    Article  CAS  PubMed  Google Scholar 

  68. Carr AJ, Murphy R, Dakin SG, Rombach I, Wheway K, Watkins B et al (2015) Platelet-rich plasma injection with arthroscopic acromioplasty for chronic Rotator Cuff tendinopathy: a randomized controlled trial. Am J Sports Med 43(12):2891–2897

    Article  PubMed  Google Scholar 

  69. Moraes VY, Lenza M, Tamaoki MJ, Faloppa F, Belloti JC (2014) Platelet-rich therapies for musculoskeletal soft tissue injuries. Cochrane Database Syst Rev 4:CD010071

    PubMed  Google Scholar 

  70. Liddle AD, Rodriguez-Merchan EC (2014) Platelet-rich plasma in the treatment of Patellar tendinopathy: a systematic review. Am J Sports Med 43:2583–2590

    Article  PubMed  Google Scholar 

  71. Warth RJ, Dornan GJ, James EW, Horan MP, Millett PJ (2015) Clinical and structural outcomes after arthroscopic repair of full-thickness rotator cuff tears with and without platelet-rich product supplementation: a meta-analysis and meta-regression. Arthroscopy 31(2):306–320

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Centre, Room Hs-106,’s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands

    Robert-Jan de Vos

Authors
  1. Robert-Jan de Vos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Robert-Jan de Vos .

Editor information

Editors and Affiliations

  1. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

    Paul W. Ackermann

  2. McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada

    David A. Hart

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

de Vos, RJ. (2016). Does Platelet-Rich Plasma Increase Tendon Metabolism?. In: Ackermann, P., Hart, D. (eds) Metabolic Influences on Risk for Tendon Disorders. Advances in Experimental Medicine and Biology, vol 920. Springer, Cham. https://doi.org/10.1007/978-3-319-33943-6_25

Download citation

Publish with us

Policies and ethics

Search

Navigation