Platelet rich Plasma

Dr.Syed Imran

Definition

• Platelet rich plasma (PRP), also termed autologous platelet gel, plasma rich in growth factors (PRGF)

• increased concentration of autologous platelets suspended in a small amount of plasma

Procurement

• centrifuged at varying speeds until it separates into 3 layers

• 1.PPP• 2.Red fraction• 3.PRP ( highest specific gravity)

Contents

• TGF Beta• PDGF• IGF• VEGF• EGF• FGF-2

Uses

• Sports medicine• Orthopaedics• Traumatology• General surgery• Dentistry• Cosmetology

Sports medicine

• tendons, ligaments and muscles• Tennis elbow• golf elbow• Achilles tendon damage • plantar fasciitis• rotator cuff syndrome• adductor• muscle enthesopathy• jumper’s knee• runner‘s knee,

• most predisposed to

Achilles tendon damage take part in running,

badminton, squash or cold weather training

• considered as a secondary step of

treatment, occurring after or in association with physiotherapy, eccentric training and manual therapy, but prior to surgery, or in order to avoid such procedures as open tendon cleaning or the more widely used Achilles tendon tendoscopy

Arthroscopic uses

• increase the efficiency of healing grafts in anterior cruciate ligament reconstructive knee surgery.

• to revitalize the graft employed in anterior cruciate ligament reconstruction in the case of its failure. If the continuity of the graft structure is maintained,albeit with weakened mechanical integrity during the arthroscopic procedure

• attempts to use PRP in the treatment of articular surface damage fractures, pseudoarthritis, skeletal reconstructions, in joint replacements, as well as fibrous dysplasia and bone inflammation

• (Franchini et al., 2005). Kawasumi et al. Describe the use of PRP in the treatment of chronic inflammations of the bones

• In most cases, they observed permanent healing of wounds and no recurrence of infection for at least a year. Bielecki et al. confirmed the bacteriostatic and bactericidal properties

Bone healing

• Many of these factors have shown to enhance osteogenesis

• PDGF,FGF,EGF :Stimulate osteoblastic progenitors

• TGF-Beta increases matrix synthesis (type 1 collagen )

• VEGF FGF-2 Angiogenic factors

• Effect of PRP or PDGF on clot microenvironment might be positive or negative

• Depends on clinical setting,graft site local environment

• Recent in vitro studies suggest that PRP can inhibit BMP’s

• They are not a source of osteogenic cells• Their effects depend on presence of

osteogenic population

Effectiveness ???

• Donor dependent• Composition depends on preparation

method• Outcomes are not uniform

FAQ

• How to adminster ?

• How many injections ?• Duration between injections ?

• Any side effects ?

• Can be availed by all ?• Severe anemia, low platelet count,

abnormal platelet function, active systemic infection or active cancer are all contra-indications

• Availability in India ?• Cost ???

Interleukin-6

• Elevated serum IL-6 levels 12 hours after trauma correlated with an increased likelihood of having FES develop; no significant relationship was observed between IL-6 levels at 6 or 24 hours and the development of FES.

• Patients with FES had a mean IL-6 level of 131 pg/mL, whereas those without FES had a mean IL-6 level of 72 pg/mL. Peak IL-6 levels were observed at 12 hours.

• IL-6 is one of the most important cytokine in acute inflammatory phase and is released very early in inflammatory process.

• Although there are many inflammatory markers, we selected IL-6 as a marker for a few reasons. Firstly the ELISA kit for measuring IL-6 required 0.5 mls of blood for each measurement.

• Secondly, IL-6 is an inflammatory marker that is activated in the early phase of the acute inflammatory response.

Thank You

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