Can Platelet-Rich Plasma Enhance Tendon Repair? A Cell Culture Study

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From: The American Journal of Sports Medicine(Vol. 36, Issue 6)
Publisher: Sage Publications, Inc.
Document Type: Article
Length: 6,578 words
Lexile Measure: 1620L

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platelet-rich plasma; tendon; growth factors; collagen; matrix metalloproteinases

1171 Can Platelet-Rich Plasma Enhance Tendon Repair?A Cell Culture Study SAGE Publications, Inc.200810.1177/0363546508314430 Mariekede Mos MD Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands, m.demos@erasmusmc.nl Anna E.van der Windt MSc Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands HolgerJahr PhD Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands Hans T. M.van Schie DVM, PhD Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands Faculty of Veterinary Medicine, Department of Equine Sciences, Utrecht University, Utrecht, the Netherlands HarrieWeinans PhD Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands Jan A. N.Verhaar MD, PhD Department of Orthopaedics, Erasmus MC University Medical Center, Rotterdam, the Netherlands Gerjo J. V. M.van Osch PhD Department of Otorhinolaryngology, Erasmus MC University Medical Center, Rotterdam, the Netherlands Faculty of Veterinary Medicine, Department of Equine Sciences, Utrecht University, Utrecht, the Netherlands +Marieke de Mos, MD, and Anna E. van der Windt, MSc, are equal contributors to this work. No potential conflict of interest declared.

Background: Autologous platelet-rich plasma (PRP) application appears to improve tendon healing in traumatic tendon injuries, but basic knowledge of how PRP promotes tendon repair is needed.

Hypothesis: Platelet-rich plasma has a positive effect on cell proliferation and collagen production and induces the production of matrix-degrading enzymes and endogenous growth factors by human tenocytes.

Study Design: Controlled laboratory study.

Methods: Human tenocytes were cultured 14 days in 2% fetal calf serum medium complemented with 0%, 10%, or 20% vol/vol platelet-rich clot releasate ([PRCR] the active releasate of PRP) or platelet-poor clot releasate (PPCR). At day 4, 7, and 14, cell amount, total collagen, and gene expression of collagen Ia1 (COL1) and IIIa1 (COL3), matrix metalloproteinases ([MMPs] MMP1, MMP3, and MMP13), vascular endothelial-derived growth factor (VEGF)-A, and transforming growth factor (TGF)-b1 were analyzed.

Results: Platelet numbers in PRP increased to 2.55 times baseline. Growth-factor concentrations of VEGF and platelet-derived growth factor (PDGF)-BB were higher in PRCR than PPCR. Both PRCR and PPCR increased cell number and total collagen, whereas they decreased gene expression of COL1 and COL3 without affecting the COL3/COL1 ratio. PRCR, but not PPCR, showed upregulation of MMP1 and MMP3 expression.

Matrix metalloproteinase 13 expression was not altered by either treatment.

PRCR increased VEGF-A expression at all time points and TGF-b1 expression at day 4.

Conclusion: In human tenocyte cultures, PRCR, but also PPCR, stimulates cell proliferation and total collagen production. PRCR, but not PPCR, slightly increases the expression of matrix-degrading enzymes and endogenous growth factors.

Clinical Relevance: In vivo use of PRP, but also of PPP to a certain extent, in tendon injuries might accelerate the catabolic demarcation of traumatically injured tendon matrices and promote angiogenesis and formation of a fibrovascular callus.

Whether this will also be beneficial for degenerative tendinopathies remains to be elucidated.

platelet-rich plasma tendon growth factors collagen matrix metalloproteinases Traumatic tendon injuries and tendinopathies are a growing problem in sports medicine and orthopaedic practice.4,17 Most tendons have the...

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