The use of Platelet-Rich Plasma (PRP) to treat chronic tendinopathies: a technical analysis

Platelet-rich plasma (PRP) is blood plasma with a high concentration of autologous platelets which constitute an immense reservoir of growth factors. The clinical use of PRP is widespread in various medical applications. Although highly popular with athletes, the use of PRP for the treatment of tendinopathies remains scientifically controversial, particularly due to the diversity of products that go by the name of ‘PRP.’ To optimize its use, it is important to look at the various stages of obtaining PRP. In this literature review, we take a closer look at eight parameters which may influence the quality of PRP:
1. anticoagulants used to preserve the best platelet function,
2. the speed of centrifugation used to extract the platelets,
3. the platelet concentrations obtained,
4. the impact of the concentration of red and white blood cells on PRP actions,
5. platelet activators encouraging platelet degranulation and, hence, the release of growth factors, and
6. the use or nonuse of local anesthetics when carrying out infiltration.
In addition to these parameters, it may be interesting to analyze other variables such as 7. the use of ultrasound guidance during the injection with a view to determining the influence they have on potential recovery.
In conclusion, there is a lack of standardization in PRP preparation technique for tendinopathies. However, it appears that the use of a platelet concentration lower than 5 times the baseline and avoidance of leukocytes should be preferred.