ORTHTR 10798 No.

of Pages 9

REVIEW/SPECIAL ISSUE
Orthopaedics
and
Sports Orthop. Traumatol. xx, xx–xx (2015)
ß Elsevier GmbH
Traumatology www.SOTjournal.com
http://dx.doi.org/10.1016/j.orthtr.2015.07.003

Abstract REVIEW/SPECIAL ISSUE

The use of platelet-rich plasma (PRP) in
sports medicine is a recently developed
technique in which concentrated autol-
Platelet-rich Plasma:
ogous blood is used to increase the
healing rate of various tissues. PRP
Applications in Sports Medicine
has been most extensively used in
the treatment of different musculoske- Won Bong Lim1,2, Sang Ha Park2, Young Lae Moon2
letal disorders, particularly in athletic 1
Department of Premedical Science, College of Medicine, Chosun University,
injuries. Owing to its apparent safety Dong-Gu, Gwangju, Korea
and ease of preparation and adminis- 2
Department of Orthopaedic Surgery, Chosun University Hospital, Dong-Gu,
tration, there has been an increased
Gwangju, Korea
interest in the efficacy of PRP in a large
number of different clinical settings. Eingegangen/submitted: 16.06.2015; überarbeitet/revised: 03.07.2015; akzeptiert/accepted: 07.07.2015
PRP has been used to treat conditions Online verfügbar seit/Available online: xxx
such as lateral epicondylitis, ligamen-
tous strains, muscular strains, and frac-
ture nonunion in athletes. PRP can be
injected to the site of the pathology, Introduction basic and clinical published investi-
either during surgery or in the phys- gations concerned about thera-
ician’s office. The benefits of PRP in the As a relatively new autologous peutic efficacy of PRP in sports-
clinical field appear to be promising, source, platelet-rich plasma (PRP) related injuries and disorders
and many investigators are still explor- has come into the spotlight in the [3,15,21,24,31,38,44].
ing new ways to use this therapy effec- field of orthopedic surgery. PRP, a so- Athletes are known to be early
tively. However, the clinical evidence called buffy coat product, is prepared adopters of novel treatment
for the benefits of PRP in the field of from freshly drawn autologous blood. methods. They like to find less inva-
sports medicine is unclear. The purpose
It is a mixture of platelet- and leu- sive methods for injury management,
of this article was to review the current
evidence on PRP therapy in this field. kocyte-rich plasma, activated with to enable a fast return to their sports.
thrombin to produce a viscous gel Additionally, they tend to choose
Keywords cloth [11]. It contains a high con- treatments which have little or no
Platelet-rich plasma – sports medicine – growth centration of platelets along with at published peer-reviewed evidence
factor – PRP least 6 abundant platelet growth fac- of efficacy, mostly due to the fact
tors such as platelet-derived growth that it takes many years for new
W.B. Lim et al.
factor (PDGF) and transforming treatment modalities to be fully-vali-
Thrombozytenreiches growth factor (TGF), within a-gran- dated by large, prospective, random-
Plasma: seine Anwendung in ules, each of which has a specific ized controlled trials [25]. Because of
der Sportmedizin function during wound repair [1,32]. these demands, PRP be an attractive
PRP has been applied in many fields. option for novel use by clinicians in
Zusammenfassung Since the first use by Ferrari in 1987 sports medicine.
during an open heart operation as an As summarized by Smith et al. [42]
Die Anwendung von thrombozytenrei-
chem Plasma (pl€attchenreiches Plasma autologous transfusion component ‘‘In surgical settings, PRP decreases
oder PRP) in der Sportmedizin ist eine to avoid homologous blood product the frequency of intraoperative and
erst k€urzlich entwickelte Technik, bei transfusion, there have been over postoperative bleeding’’ at the sur-
der konzentriertes autologes Blut ein- 5200 medical research publications gical sites; ‘‘accelerates soft-tissue
gesetzt wird, um die Heilungsge- related to PRP recorded in the healing; supports the initial
schwindigkeit verschiedener Gewebe- National Center for Biotechnology stability of grafted tissue at the
arten zu erh€ohen. PRP kommt h€aufig Information database (NCBI) in var- recipient sites as a result of its cohe-
bei verschiedensten Erkrankungen des ious specialties, including sports sive and adhesive nature; promotes
Bewegungsapparates, vor allem aber medicine, neurosurgery, ophthal- rapid vascularization of healing tis-
bei Sportverletzungen zum Einsatz. Die mology, dentistry, wound healing, sue by delivering growth factors
einfache Herstellung und die scheinbar
orthopedics, and cardiothoracic and, when used in combination with
sichere Anwendung sowie die unkom-
plizierte Verabreichung haben zu einem and maxillofacial surgery [32]. bone replacement materials, indu-
Particularly, there have been many ces regeneration’’.

W.B. Lim et al. 

Platelet-rich Plasma: Applications in Sports Medicine 1
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verst€arkten Interesse an der Wirksam- Nevertheless, few clinical studies red blood cells to platelets is found
keit der PRP-Anwendung in unter- have quantified the actual com- to be reversed; thereby, the concen-
schiedlichen klinischen Einsatzberei- ponents that are used in treatment, tration of platelet related factors
chen gef€uhrt. PRP wird bei Erkrankun- and a standard formulation or dosage becomes higher, which is thought
gen wie Epicondylitis humeri radialis, of PRP is not yet recorded. Therefore, to be more effective in healing.
Bandverletzungen, Muskelverletzun-
gen und der Fraktur- und Pseudarthro-
guidelines for PRP therapy appli- The exact ratio of red and white
senbehandlung bei Sportlern einge- cation must be developed in order blood cells to platelets in PRP is
setzt. PRP kann entweder w€ahrend der to encourage and assist physicians variable depending on the way in
Operation oder im Sprechzimmer des to use it safely, and to develop robust which the PRP is prepared. From a
Arztes direkt an die gew€unschte Stelle clinical research to define the scope quantitative perspective, PRP is
injiziert werden. Die Vorteile von PRP in of use of PRP and its anticipated broadly defined as a sample of autol-
der klinischen Anwendung scheinen effects. This article will attempt to ogous plasma with platelet concen-
vielversprechend zu sein und viele For- review the scientific basis and cur- trations above baseline. To develop
scher suchen noch immer neue Wege, rent state of applicable indications, more specific preparations, some
diese Therapie effektiv zu nutzen und and suggest a path forward for its use research groups have adopted a
weiter zu entwickeln. Jedoch konnten in sports medicine. more objective definition of 5 times
die klinischen Nachweise f€ur die vor-
teilhafte Anwendung von PRP im Be-
the platelet concentration of whole
reich der Sportmedizin bisher nicht ein- blood, that is, 1,000,000 per mL
deutig erbracht werden. Dieser Artikel Basic concepts of PRP platelet count.
beleuchtet die aktuellen Erkenntnisse Platelets have to be activated with
der PRP-Therapie in der Sportmedizin To obtain PRP, a sample of the thrombin and calcium upon appli-
und pr€uft diese kritisch. patient’s blood was taken and cen- cation of the resultant gel to the
trifuged to concentrate autologous surgical site [25,38]. This process
€sselwo
Schlu €rter platelets (Fig. 1). The whole blood leads to the formation of a blood
Thrombozytenreiches Plasma – Pl€attchenreiches
Plasma – Sportmedizin – Wachstumsfaktor – PRP sample normally contain 93% red clot, in which platelets predominate
blood cells, 6% platelets, and 1% over red blood cells in a ratio
white blood cells. The average pla- reversed that of a natural clot.
telet concentration in a whole blood Surgical lesions or wounds enhanced
sample is about 200,000 per mL with PRP heal at rates two to three
(normal range 150,000-350,000 times faster than untreated surgical
per mL) [36]. In PRP, the ratio of sites [20,39].

Figure 1
Schematic image of PRP preparation. A) Centrifugation of whole blood B) whole blood
is divided into Packed RBC layer and buffy coat layer (PLT, WBC), PRP, and PPP layer.

2 W.B. Lim et al. 

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PRP can be distinguished from fibrin activation of platelet membrane platelet factor 4 (PF4), epidermal
glues or sealants, which have been receptors through which the growth factor (EGF), platelet-
used for many years as a surgical adhesive macromolecules, Von derived endothelial growth factor,
adjunct to promote local hemostasis Willebrand factor and fibrinogen, insulin-like growth factor (IGF),
[43]. The critical difference is that anchor platelets to the vessel wall osteocalcin, osteonectin, vitronec-
PRP has a high concentration of and link them to each other. A sec- tin, fibronectin, fibrinogen, and
platelets and a normal concen- ondary hemostatic plug composed of thrombospondin-1 [2]. These
tration of fibrinogen. In contrast, platelets enmeshed in fibrin is growth factors are polypeptide
autologous fibrin glues or sealants formed through the action of throm- dimers, comprising two antiparallel
can be created from platelet-poor bin, which is essential for the for- monomers that are arranged in a
plasma that consists primarily of mation of fibrin and the activation cystine knot configuration. These
fibrinogen. When PRP, combined of coagulation factors V and VIII. cystines induce disulfide bonding
with thrombin and other activators The balance of all components both between and within the mono-
such as calcium, is used as an autol- (vessel wall, platelets, adhesive mer chains, which translates into
ogous formulation of fibrin glue, the proteins, coagulation factors, and similar three-dimensional structures
high concentration of platelets pro- regulatory mechanisms) determines among various growth factors. One
motes wound healing, bone growth, the effectiveness of hemostasis in intra-chain disulfide bonded loop is
and tissue sealing. maintaining the structural and func- nested within another, in a sort of
Many other variables constitute PRP tional integrity of the vessel. ‘‘C-in-a-C’’ arrangement referred to
that could affect its pathophysio- as the ‘‘cystine knot’’ [17,35].
logical properties and effectiveness Most of these growth factors have
[10,26]. The initial vascular Physical properties several isoforms, which have over-
response to injury includes the lapping but slightly different out-
release of sub-endothelial factors PRP manifests its beneficial effects comes on target cells and tissues.
that attract platelets and coagu- through degranulation of the alpha The receptors for these growth fac-
lation proteins. Platelets respond granules in platelets, which contain tors are tyrosine kinase (PDGF, EGF,
by aggregating at and adhering to growth factors, such as PDGF or TGF- IGF, and VEGF) receptors that dimer-
the site of injury where they release beta, that are believed to be import- ize themselves upon ligand binding
granules containing serotonin, ant in early wound healing. When [2,35], and then autophosphorylate
thromboxane, and adenosine, and the platelets in PRP are activated owing to tyrosine kinase activity
consequently initiate coagulation by thrombin, they release growth between the paired intracellular
and the formation of fibrin. Local factors and other substances that tails. Once phosphorylated, the
production of thrombin leads to serve to improve wound healing by tyrosine kinase itself enhances cat-
activation of platelets, and the sub- increasing cellular proliferation, alytic efficiency to phosphorylate
sequent formation of a hemostatic connective tissue healing, angio- other intracellular proteins. In
plug, which minimizes further genesis, and collagen synthesis. addition, phosphorylation of the
bleeding. Production of thrombin Platelets and the growth factors non-kinase domains provides a
and activation of platelets also which they release are essential fac- binding site for proteins that con-
initiate the process of wound heal- tors for regulating the cellular tain Src-homology 2 (SH2) domains.
ing via thrombin-dependent cell events that follow tissue damage These latter proteins induce signal-
activation and platelet dependent [29]. They adhere, aggregate, form ing pathways, including the PI3-
angiogenesis [45]. Marx reported a fibrin mesh, and subsequently kinase and phospholipase C cascades
that active secretion of growth fac- release a large variety of growth [17]. These two pathways lead to
tors begins within 10 minutes of factors and cytokines. At least 15 myriad downstream events, includ-
clotting, with more than 95% of different factors are known to be ing transcription, translation, cell
presynthesized growth factors being contained within platelets, includ- division, and migration. These
secreted within 1 hour [23]. PRP ing PDGF (PDGF-bb, -ab, and -aa specific signaling effects lead the
mimics the final step of the coagu- isoforms), TGF-beta (TGF beta, release of intracellular calcium, or
lation cascade, which is the for- -beta1, and -beta2 isoforms), plate- activation of the Ras G-proteins,
mation of a fibrin clot. In vivo, let-derived angiogenesis factor, Rac and/or Rho, causing cyto-
the development of a primary hemo- interleukin 1 (IL-1), vascular endo- skeletal reorganization and cell
static plug begins with the thelial growth factor (VEGF), migration [48]. Alternatively, the

W.B. Lim et al. 

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SH2 domains may belong to adaptor Tendon injuries had no wound complications, and
proteins that ultimately lead to the took less time to resume gentle run-
MAPK signaling cascade, which Tendon injuries are common in ning and training activities [37].
drives the cell cycle past its restric- sporting, recreational, and work- Similarly, Lyras et al. found a sig-
tion point and causes cell prolifer- related activities because of the nificant improvement in the mech-
ation [17]. While these results increase in the number of partici- anical properties of the regenerated
suggest that autologous cytokines pants and their activity level [34]. tendon in a PRP-treated group at 14
from PRP might be efficacious in Although historically these were days with a return to baseline at 28
sports medicine, the studies are more common in populations older days, concluding that PRP has a
not conclusive. Therefore, success- than age 40, a greater percentage of strong effect during the early phases
ful therapeutic use of PRP requires younger athletes now experience of tendon healing [22].
the definition of its indications, and tendon pain [8]. Symptoms of ten- Mishra and Pavelko reported the first
ultimately a better understanding of don injuries may include persistent human use of PRP for chronic severe
how to use PRP in sports medicine. pain, loss of range of motion, and elbow tendinosis in a prospective
dysfunction that can prevent a controlled pilot study [26]. They
Clinical studies in the sports return to full activity. Furthermore, found a 60% improvement in pain
field with a chronic connective tissue dis- scores in the PRP-treated patients
order, regeneration does not occur, versus a 16% improvement in the
Broad clinical applications of PRP in resulting in a dysfunctional tissue control patients at 8 weeks after
sports medicine have been reported. structure that may incur further treatment. At the final follow-up,
Particularly, the effects of PRP on injury or rupture due to a failed the PRP patients reported a 93%
tendon and bone have been inves- healing repair response [39]. reduction in pain compared with
tigated, with many studies on artic- Clinicians and athletes may find pretreatment scores. In addition,
ular tissues being performed more themselves contemplating alterna- using a similar methodology and
recently. It should be pointed out tive therapies in conjunction with the same type of PRP, Peerbooms
that these reports employ various rehabilitation or surgery (Fig. 2). et al. found significant improve-
concentrations of platelets, acti- In a recent case-controlled study ments in pain and disability scores
vation methods, and PRP products. comparing open suture repair for in a prospective double-blind
However, many reports are anecdo- Achilles tendon tears in athletes randomized controlled trial on
tal, and few include controls. In with and without the application patients with elbow tendinopathy
spite of a large number of relevant of a preparation rich in growth fac- [17]. This study enrolled 100
clinical studies, their findings are tors, subjects who received the prep- patients, after failure of a variety
often conflicting, and they lack aration recovered their range of of treatments including physical
standardization. motion earlier than control subjects, therapy, to compare PRP with corti-
sone. The initial visual analog pain
scores were found to be 70.1 and
65.8 in the PRP treated group and
control group, respectively. These
patients had significant pain that
made them seek further interven-
tion. This is an important distinc-
tion point from other studies in
which subjects had not exhausted
other treatment options. After 6
months, patients in the PRP group
reported a 53.5% improvement in
pain scores, compared to a 14%
improvement in the corticosteroid
group. At one year, the PRP patients
reported a 63.9% improvement,
Figure 2 while it was 24% in the steroid
Schematic image of PRP injection to the biceps long head tendon. group.

4 W.B. Lim et al. 

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A randomized controlled trial on 30 injection produces local bleeding, Treatment of lateral epicondylosis is
patients who had undergone surgi- which is a known irritant and of great and similar interest to clini-
cal repair of the Achilles tendon recruiter of platelets in both groups. cians and patients (Fig. 3). Mishra
reported no additional benefit with and Pavelko studied a small group of
PRP compared to standard treatment patients affected by chronic elbow
[40]. In another randomized con- tendinosis, and showed that sub-
trolled trial on patients with chronic Lateral epicondylitis jects who received PRP in a single
Achilles tendinopathy, a PRP injec- injection session had an 81%
tion was not better at improving Lateral elbow epicondylar tendino- improvement in pain scores at 6
pain and activity, compared with sis, or tennis elbow, is a common months and up to 93% improvement
saline injection [13]. De Vos et al. condition occurring at the common at 25 months compared to the pain
reported similar results. They extensor tendon that originates at baseline; however, a large loss of
showed that PRP had no statistically from the lateral epicondyle, in subjects in the control group limited
significant benefit upon clinical patients whose activities require the strength of the study con-
scoring outcomes or ultrasound strong gripping or repetitive wrist clusions [26]. An additional large-
findings in chronic Achilles tendin- movements [36,41]. It causes pain scale trial on 100 subjects compared
opathy at 24-week and 1-year fol- and functional impairment in daily PRP with corticosteroid injections. A
low-up evaluations. However, one activities [7]. Current research has statistically and clinically signifi-
should consider that saline injection produced several biological hypoth- cant difference in disease-specific
might not be the best placebo, eses regarding the cause of tendi- quality of life, measured through
because it likely has an active role nosis based on histopathological, pain scores, emerged in favor of
in tendinopathy recovery. Injecting biochemical, and clinical findings the PRP group [30]. Interestingly,
saline into the tendon alters the that show cell apoptosis, angiofibro- the PRP group progressively
pressure-volume relationship in a blastic features, and/or abnormal improved at 1 year, compared with
given space, thereby disrupting biochemical adaptations. Those the steroid group, which worsened
pathological vascular and neural findings largely suggest that a failed after an initial short-term improve-
ingrowth [33]. Additionally, the healing response underlies this con- ment, suggesting that progressive
needle-related trauma of the dition [12]. healing may be responsible for

Figure 3
Ultrasound-guided PRP injection for lateral epicondylitis. A) Schematic image, B) Real image of ultrasound-guided PRP injection,
note proper placement of the needle (arrowhead).

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Figure 4
PRP injection in a female 45 year old patient. A) before the treatment, coronal MRI shows lateral epicondylitis, B) On 3 months
follow-up after PRP injection, the MRI shows decrease of signal intensity at origin of ECRB, in addition there is improvement in the
patient‘s Mayo (32 to 65) and Oxford (15 to 32) clinical scores.

clinical improvement in the PRP sub- pain, healing, and graft quality. of the graft, as visualized by MRI at 6
jects. Gosens et al. reported similar Anecdotal evidence from experts months [28]. Similarly, another ACL
results at a 2-year follow-up and indicates improved time for healing, reconstruction study demonstrated
showed that PRP injection improved reduced pain, and reduced time to that locally-applied platelet gel
healing, compared with corticoste- return to sports. PRP has also been enhanced early revascularization of
roid injection [14]. Moreover, explored in ACL reconstruction. The the graft at the interface, leading to
another report demonstrated that ability of PRP to enhance graft fill- better anteroposterior knee stability
a single PRP injection improved pain ing into bone tunnels and the at 6 months [46].
and function scores in 29 patients possibility of reducing donor site Other ligamentous injuries that have
who failed to improve with a 6 morbidity have both been eval- been treated with PRP include ulnar
months of corticosteroid treatment uated. Two randomized controlled collateral ligament injuries of the
[16] (Fig. 4). trials showed no statistically signifi- elbow, acromioclavicular joint inju-
cant difference in bone filling of the ries, sternoclavicular joint injuries,
tunnels made during ACL reconstruc- and partial tears of the scapholunate
Ligament injuries tion procedure, as visualized by ligament.
magnetic resonance imaging PRP is used for sports hernias occur-
Almost all studies on the use of PRP (MRI). Nevertheless, one of these ring because of weakness of the
in ligament injuries to date have studies found an improvement in posterior inguinal wall associated
been in combination with surgical the clinical score [5]. Another with changes in the conjoint ten-
anterior cruciate ligament (ACL) randomized controlled trial of 108 don, insertion of the rectus abdom-
reconstruction. Overall, the evi- patients showed that PRP had an inis, and adductors. Therefore, PRP
dence suggests improvements in enhancing effect on the maturation use for treating hernias is gaining

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popularity. However, studies are frequent occurrence of re-injury. performed at 1-week intervals
needed to confirm the clinical Finally, PRP can be expensive, and [27]. At 6-month follow-up, signifi-
effects of PRP on sports hernias. the cost may prohibit many less cant improvement was observed in
well-funded athletes from utilizing subjective scores. Of equal import-
this treatment. ance, no adverse events were
Muscle injuries observed. More promising results
were shown in less severe stages of
Muscle strain is a very common Cartilage Injuries OA. Taken together, PRP represents
source of pain and dysfunction, a promising option for treating
particularly in the athlete. Muscles A particular application of PRP is to patients with cartilage injuries.
are rich in blood supply and gener- stimulate cartilage repair [25]. However, standardized preparation
ally heal, with the usual care, Osteoarthritis (OA) is a chronic and usage protocols are required in
approximately 8 times faster than degenerative condition of hyaline order to obtain statistically signifi-
ligaments. If a subacute or chronic cartilage. OA accounts for signifi- cant outcomes in future studies.
condition develops, PRP treatment cant pain, morbidity, and health
is considered acceptable. In rare care expense. The consequences of
situations, PRP can be considered OA for individuals and the popu-
in an acute injury in an attempt to lation as a whole are very signifi- Conclusion
facilitate function, but there is cant, particularly with an aging
insufficient evidence to endorse population. It is thought that PRP There is good experimental evidence
this. Muscle healing is an intricate can stimulate chondral anabolism to support PRP use in sports medi-
and dynamic process aimed at and reduce catabolic processes, cine, particularly in tendon injuries,
restoration of anatomical continuity and as a result may improve overall ligament injuries, and arthropa-
and function of the injured muscle joint homeostasis, thereby reducing thies. The use of autologous PRP
[4]. Cugat et al. conducted a cohort synovial membrane hyperplasia is a relatively new biotechnology
study of 14 professional athletes [19]. With regard to the clinical technique that has shown promise
with acute muscle injuries that were application of PRP in the treatment for stimulating and accelerating
treated with ultrasound-guided of cartilage defects or OA, Kon et al. soft-tissue healing. The efficacy of
injections of PRP [9]. Such patients injected PRP into 115 knees this treatment lies in the local deliv-
showed a quick return to play, with documented degeneration. ery of a wide range of growth factors
and showed enhanced healing of Significant improvement in all and proteins, mimicking and
tears on ultrasound assessment. clinical scores was found at 6-12 supporting physiological wound-
Similarly, Sanchez et al. reported a months, compared to baseline. healing and reparative tissue proc-
recovery time that was twice as fast They found that PRP injections are esses. Consequently, the application
as expected in 20 athletes [38]. safe, with a potential to reduce pain of PRP has been extended to many
However, some researchers have and improve knee function [18]. different fields, including orthope-
suggested that PRP may actually Further evidence on the clinical dics, sports injuries, dental and
lead to unwanted fibrotic healing effects of PRP was shown by periodontal surgery, plastic, cardio-
in muscle [6]. Wang-Saegusa et al., who performed vascular, general, and maxillofacial
As opposed to a chronically degen- a prospective study on 261 patients surgery. The current increase in pro-
erative tendon, muscle is an actively with unilateral or bilateral knee OA, spective randomized controlled
healing, acutely inflammatory with symptoms of more than 3 clinical studies will likely continue
entity. There is therefore the poten- months duration [47]. All patients to substantiate the use of PRP as a
tial to affect both the timing and the received a series of three injections, therapeutic agent in orthopedics
quality of repair, negatively as well 2 weeks apart. At 6 months, statisti- and sports medicine. However,
as positively. Some types of PRP may cal analysis revealed significant because of the autologous nature
prove more beneficial or harmful improvement in all the scores used of the product, standardized results
than other types. The timing and in the study. Napolitano et al. may not be obtained in all patients.
quantity of injections required are also evaluated the treatment of Experimental studies are still necess-
also in question. Acute muscle inju- 27 patients who had either simple ary to optimize each of the variables
ries are typically self-limited and chondropathy or initial OA, using involved in PRP preparation and use,
heal if given enough time, despite three injections of 5 ml PRP so that the best PRP product possible

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can be produced from and delivered [7] A.O. Chourasia, K.A. Buhr, D.P. Clinical oral implants research. 17
to each individual patient. Rabago, R. Kijowski, K.S. Lee, M.P. (2006) 212–219.
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Sesto, Relationships between biome- vanDemden, G.M. Kiebzak, Platelet-
Conflict of interest chanics, tendon pathology, and func- rich plasma injection reduces pain in
tion in individuals with lateral patients with recalcitrant epicondyli-
epicondylosis, The Journal of ortho- tis, Orthopedics. 34 (2011) 92.
There is no conflict of interest. paedic and sports physical therapy. [17] C.H. Heldin, B. Westermark,
43 (2013) 368–378. Mechanism of action and in vivo role
[8] B.K. Coombes, L. Bisset, B. Vicenzino, of platelet-derived growth factor,
Acknowledgement Efficacy and safety of corticosteroid Physiological reviews. 79 (1999)
injections and other injections for 1283–1316.
This study was supported by a grant management of tendinopathy: a sys- [18] E. Kon, R. Buda, G. Filardo, A. Di
of Huons Co., Ltd. pharmaceutical tematic review of randomised con- Martino, A. Timoncini, A. Cenacchi,
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[9] R. Cugat, X. Cusco, R. Seijas, P. Alvarez, articular knee injections produced
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centre randomized controlled trial, techniques in orthopaedics: platelet- Philmundaero, Dong-ku,
BMC musculoskeletal disorders. 11 rich plasma, Orthopedic nursing. 30 Gwangju 501-717, South Korea
(2010) 69. (2011) 260–263, quiz 264–5. Tel.: +82-62-220-3791
[32] W.S. Pietrzak, B.L. Eppley, Platelet rich [42] R.G. Smith, C.J. Gassmann, M.S. Fax: +82-62-226-3379.
plasma: biology and new technology, Campbell, Platelet-rich Plasma: E-Mail: [email protected]

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