Platelet-rich plasma in tendon-related disorders: results and indications.
OBJECTIVE
Platelet-rich plasma (PRP) is currently the most exploited strategy in the clinical practice to provide a regenerative stimulus for tendon healing. The aim of the present study was to systematically review the available evidence on the treatment of the main tendon disorders where PRP is currently applied.


METHODS
A systematic review of the literature was performed on the use of PRP as a treatment for tendinopathies focusing on the following sites: Achilles tendon, patellar tendon, rotator cuff tendons, and lateral elbow tendons. The following inclusion criteria for relevant articles were used: clinical trials written in English language up to 21 June 2016 on the use of PRP in the conservative or surgical treatment of the aforementioned tendinopathies.


RESULTS
The research identified the following clinical trials dealing with the application of PRP in the selected tendons: 19 papers on patellar tendon (6 being RCTs: 4 dealing with PRP conservative application and 2 surgical), 24 papers on Achilles tendon (4 RCTs: 3 conservative and 1 surgical), 29 on lateral elbow tendons (17 RCTs, all conservative), and 32 on rotator cuff (22 RCTs: 18 surgical and 3 conservative).


CONCLUSIONS
Patellar tendons seem to benefit from PRP injections, whereas in the Achilles tendon, PRP application is not indicated neither as a conservative approach nor as a surgical augmentation. Lateral elbow tendinopathy showed an improvement in most of the high-level studies, but the lack of proven superiority with respect to the more simple whole-blood injections still questions its use in the clinical practice. With regard to rotator cuff pathology, the vast majority of surgical RCTs documented a lack of beneficial effects, whereas there is still inconclusive evidence concerning its conservative application in rotator cuff disorders.


METHODS
Systematic review of level I-IV trials, Level IV.
Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
Giuseppe
G
Filardo
I Orthopaedic and Traumatologic Clinic, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy. berardo.dimatteo@gmail.com.
Berardo
B
Di Matteo
Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
Elizaveta
E
Kon
Nano-Biotechnology Laboratory, Rizzoli Orthopaedic Institute, Bologna, Italy.
Giulia
G
Merli
Biomechanics and Technology Innovation Laboratory, Rizzoli Orthopaedic Institute, Via Di Barbiano, 1/10, 40136, Bologna, Italy.
Maurilio
M
Marcacci
D000125:Achilles Tendon / Q000293:injuries; D000070639:Elbow Tendinopathy / Q000628:therapy; D006801:Humans; D007267:Injections; D017847:Patellar Ligament / Q000293:injuries; D053657:Platelet-Rich Plasma; D012038:Regeneration; D017006:Rotator Cuff; D000070636:Rotator Cuff Injuries / Q000628:therapy*; D052256:Tendinopathy / Q000628:therapy*; D016896:Treatment Outcome
Achilles tendon; Growth factors; Lateral elbow; PRP; Patellar tendon; Review; Rotator cuff; Tendinopathy
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