Abstract :
[en] Platelets have known roles in coagulation, inflammatory processes, and immunity modulation; they also have ‘‘restorative’’ properties. Indeed, during degranulation, platelets release different cytokines and growth factors (VEGF, PDGF, TGF-B, IGF-I, and HGF) that promote angiogenesis, tissue remodeling (bone, skin, muscle, tendon, etc.), and wound healing. PRP is obtained by centrifuging autologous blood to obtain a concentration of platelets, usually between 3 and 10 times that of whole blood, depending on the isolation method. For this reason, different PRP preparation techniques cannot provide a consistently identical final product, but there is currently no international consensus on this issue. Overall, PRP could be an attractive therapeutic option for treating chronic musculoskeletal conditions, such as tendinopathy or plantar fasciitis.
Tendons do not have a high metabolic index. Growth factors released by platelets promote tenocyte proliferation, stimulate angiogenesis and have analgesic properties. Thus it could stimulate and accelerate tissue regeneration in animal models. In addition to PRP, optimal tissue quality requires the application of mechanical loads. PRP should be considered for chronic tendinopathies. Indeed, the goal is to initiate an acute inflammatory reaction that quickly moves on to the proliferative phase that involves collagen synthesis. The latter is necessary for appropriate tendon healing. PRP should therefore not be used for acute tendinitis or tenosynovitis.
Even if most of the preclinical studies showed that PRP stimulates the tendon healing process, clinical series remain more controversial. Based on literature and our clinical experience, we suggest some ideas for improving this treatment. Optimization of the technique for collecting the PRP is paramount. Different risk factors must be corrected before infiltration, and chronic tendinopathies must be carefully selected. Finally, post-infiltration rehabilitation remains absolutely necessary. Standardisation of the use of PRP remains necessary in order to optimise the results.
