Systematic Reviews
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Jul 18, 2019; 10(7): 278-291
Published online Jul 18, 2019. doi: 10.5312/wjo.v10.i7.278
Platelet-rich plasma for muscle injuries: A systematic review of the basic science literature
Kyle N Kunze, Charles P Hannon, Jared D Fialkoff, Rachel M Frank, Brian J Cole
Kyle N Kunze, Charles P Hannon, Jared D Fialkoff, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL 60612, United States
Rachel M Frank, Department of Orthopedic Surgery, University of Colorado School of Medicine, Boulder, CO 80309, United States
Brian J Cole, Department of Orthopedics, Rush University Medical Center, Chicago, IL 60612, United States
Author contributions: Hannon CP conceived the study idea and designed the research with Kunze KN; Kunze KN wrote the manuscript and analyzed the data; Kunze KN and Fialkoff JD collected the data; Kunze KN, Hannon CP, Frank RM and Cole BJ edited and revised the manuscript.
Conflict-of-interest statement: Dr. Cole reports personal fees from Arthrex, personal fees from Geistlich Pharma, personal fees from Smith & Nephew, personal fees from Bioventus, personal fees from Vericel, personal fees from Zimmer Biomet, personal fees from Anika Therapeutics, personal fees from Pacira Pharmaceuticals, personal fees from Isto Technologies, personal fees from DJO, personal fees from Encore Medical, personal fees from LifeNet Gealth, personal fees from Carticept Medical, personal fees from GE Healthcare, personal fees from Aesculap Biologics, personal fees from DePuy Synthes, personal fees from Genzyme, during the conduct of the study; Dr. Frank is a paid presenter for Arthex, Inc. and reports personal fees from Elsevier, during the conduct of the study.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kyle N Kunze, BSc, Research Fellow, Department of Orthopedic Surgery, Rush University Medical Center, 1611 West Harrison Street, Chicago, IL60612, United States. kyle_n_kunze@rush.edu
Telephone: +1-609-2149245 Fax: +1-708-4095179
Received: February 13, 2019
Peer-review started: February 15, 2019
First decision: April 16, 2019
Revised: May 10, 2019
Accepted: June 25, 2019
Article in press: June 25, 2019
Published online: July 18, 2019
Processing time: 155 Days and 10.4 Hours
Abstract
BACKGROUND

Platelet-rich plasma (PRP) is an increasingly used biologic adjunct for muscle injuries, as it is thought to expedite healing. Despite its widespread use, little is known regarding the mechanisms by which PRP produces its efficacious effects in some patients.

AIM

To clarify the effects of PRP on muscular pathologies at the cellular and tissue levels by evaluating the basic science literature.

METHODS

A systematic review of PubMed/MEDLINE and EMBASE databases was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and checklist. Level III in vivo and in vitro studies examining PRP effects on muscles, myocytes and/or myoblasts were eligible for inclusion. Extracted data included PRP preparation methods and study results.

RESULTS

Twenty-three studies were included (15 in vivo, 6 in vitro, 2 in vitro/in vivo). Only one reported a complete PRP cytology (platelets, and red and white blood cell counts). Five in vitro studies reported increased cellular proliferation, four reported increased gene expression, and three reported increased cellular differentiation. Five in vivo studies reported increased gene expression, three reported superior muscle regeneration, and seven reported improved histological quality of muscular tissue.

CONCLUSION

The basic science literature on the use of PRP in muscle pathology demonstrates that PRP treatment confers several potentially beneficial effects on healing in comparison to controls. Future research is needed to determine optimal cytology, dosing, timing, and delivery methods of PRP for muscle pathologies.

Keywords: Platelet rich plasma; Basic science; Muscle; Musculoskeletal; Injury

Core tip: Platelet-rich plasma (PRP) has gained much attention in the treatment of muscle injuries for its potential beneficial effects in both operative and non-operative settings without knowledge of its mechanism of action. The current systematic review synthesizes the effects of PRP at the basic science level. PRP was found to induce cellular proliferation and differentiation, the production of various growth factors, muscle regeneration, and changes in gene expression. Only one study reported a complete PRP cytology. This study highlights the underlying mechanisms of PRP in muscle pathology at the basic science level, and emphasizes the need for standardization in PRP preparation and reporting.