Dr. Héctor Nuila – Dr. Giovanni Figueroa
Traumatology and Orthopedics
Plasma rich in platelets (PRP) or Plasma Rich in Growth Factors (PRGF) consists of a multi-factor and molecular approach that acts simultaneously in different cell types and the diverse mechanisms implicated in repairing damaged tissues, such as formation of new blood vessels (angiogenesis), cell proliferation and differentiation, the synthesis of extracellular matrix and remodeling. It is based on use of platelets as vehicle for controlled liberation of different cellular signals that accelerate and optimize repair of tissue damaged by diverse reasons such as surgical treatment, traumatism or disease. Platelets contain numerous substances but in highly reduced concentrations that have nothing to do with pharmacological doses we are used to. Growth factors are proteins that play an essential role in the tissue regeneration process. Those proteins intervene in cell communication, as they send information when interacting with receptors placed in the cell membrane. They also act simultaneously in different cell types and unchain biological effects such as directed cell migration (displacement called chemotaxis), cell proliferation and differentiation, formation of new blood vessels (angiogenesis), etc. All of them are fundamental events for tissue repair and regeneration. The purpose of using PRP is to imitate and optimize through it physiological repair mechanisms that are spontaneously triggered in all tissues after injury caused by trauma, surgical treatment or disease.
Preparation consists of drawing blood from the patient, centrifugation of the sample and separation the fraction with plasma and platelet concentrate. Red blood cells are always separated. Leukocytes can be included or not, according to manner of preparation. Many companies have placed their kit for this therapy in the market. In just 3 to 6 minutes, activated liquid PRP transforms into a fibrin and cell components tridimensional matrix drenched in growth factors. This PRP clot can be used in multiple applications that range from regeneration of an alveolus after extracting an implant to treatment of muscle-skeleton or vascular pathologies.
The PRP preparation can be applied as local infiltration, as intra-articular infiltration as fibrin gel rich in platelets; the latter is the most solid and most frequently used way in the operating room.
Apart from frequent use in other specialties such as maxillofacial surgery or plastic surgery, PRP therapy has been applied in sports traumatology to injuries of the locomotor system:
It is frequently applied in:
- Ruptured tendons
- Chronic tendinopathy
- Muscular injury
- Focal cartilage injuries
- Ligament injuries
- Fractures and pseudoartrosis.