JOREP 3 (2024) 100287

Contents lists available at ScienceDirect

Journal of Orthopaedic Reports

journal homepage: www.journals.elsevier.com/journal-of-orthopaedic-reports

Therapeutic uses of platelet-rich plasma (PRP) in sport injuries – A

narrative review
Prasad Patil a, Mamtha Jadhav a, Tarun Kumar Suvvari b, c, *, Vimal Thomas d
a
Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
b
Rangaraya Medical College, Kakinada, India
c
Squad Medicine and Research, India
d
Tbilisi State Medical University, Georgia

A R T I C L E I N F O A B S T R A C T

Keywords: Introduction: Sports offer numerous health benefits, contributing to growth, development, physical fitness, and
Platelet-rich plasma mental well-being. However, injuries are an inevitable part of sports, affecting both professional athletes and
Sports injuries casual participants. The incidence of sports-related injuries has risen significantly due to increased participation,
Therapeutics
heightened competitiveness, inadequate injury prevention techniques, improper sporting gear, insufficient
Rehabilitation
Sports medicine
training, and overuse.
Method: ology: A comprehensive literature search was performed in multiple databases such as PUBMED and
SCOPUS. Relevant studies on therapeutic uses of platelet-rich plasma (PRP) in sports injuries were included. The
findings provide a comprehensive overview of the topic.
Results: Platelet-Rich Plasma (PRP) is a regenerative, minimally invasive, non-surgical procedure that accelerates
healing by utilizing concentrated bioactive factors from the body. PRP has shown promising results in treating
conditions such as patellar tendonitis, Achilles tendonitis, tennis elbow, partial rotator cuff tears, ligament tears,
and mild to moderate arthritis. Following a PRP injection, athletes typically undergo a short period of rest from
sports activities while attending rehabilitation therapy. This approach helps optimize healing and ensures an
optimal outcome.
Conclusion: PRP has shown great promise as a treatment modality for sports injuries. While further research is
needed to optimize PRP protocols and understand its mechanisms of action in sports injuries, it holds significant
potential for enhancing the recovery and rehabilitation of athletes, ultimately contributing to improved out­
comes in the field of sports medicine.

1. Introduction where regenerative procedures like Platelet-Rich Plasma (PRP) come

into play.1,2 From a clinical perspective, regenerative sports medicine
Musculoskeletal injuries in sports can occur due to trauma, improper focuses on injuries related to sports activities and aging, involving
training techniques, chronic overuse, and inadequate injury prevention various components of the musculoskeletal system such as menisci,
measures. While many of these injuries can be managed conservatively ligaments, tendons, cartilage, and bones. PRP has shown its utility as an
with approaches such as NSAIDs, physiotherapy, rehabilitation, and interventional therapy for sports injuries in specific cases. PRP is
rest, there are certain chronic injuries that do not respond well to con­ composed of over 1000 bioactive proteins that play crucial roles in
servative treatments and may require conventional surgical interven­ healing, clot formation, and hemostasis. These include fibroblast growth
tion. These chronic pathologies often involve microstructural damage to factor (FGF), platelet-derived growth factor (PDGF), vascular endothe­
tissues and bones, which may not fully recover even after surgery. Such lial growth factor (VEGF), transforming growth factor (TGF), and
injuries can have a significant impact on athletes, potentially cutting epidermal growth factor (EGF).1,2 (Table 1).
short their careers and negatively affecting their quality of life. This is PRP stimulates human tenocytes to produce matrix-degrading

* Corresponding author. Squad Medicine and Research, India.

E-mail addresses: [email protected] (P. Patil), [email protected] (M. Jadhav), [email protected] (T.K. Suvvari), drvimal4u@
gmail.com (V. Thomas).

https://doi.org/10.1016/j.jorep.2023.100287
Received 27 June 2023; Accepted 21 November 2023
Available online 25 November 2023
2773-157X/© 2023 The Author(s). Published by Elsevier B.V. on behalf of Prof. PK Surendran Memorial Education Foundation. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
P. Patil et al. Journal of Orthopaedic Reports 3 (2024) 100287

Table 1 studies have revealed that apart from their hemostatic activities, plate­
Application of PRP in sports medicine and traumatology. lets are abundant in GFs and cytokines, which can influence inflam­
Condition Application of PRP mation, angiogenesis, stem cell migration, and cell proliferation.13,14 In
addition to their role as GFs, platelets also act as chemical messengers
Achilles Tendon Rupture Effective in promoting tendon healing and accelerating
recovery and play essential roles in various tissue-level processes, including
Rotator Cuff Tears Facilitates the healing process and improves functional proliferation, differentiation, chemotaxis, and tissue morphogenesis.15
outcomes
Anterior Cruciate Enhances graft-bone integration and aids in the 1.3. Application of PRP in sports medicine and traumatology
Ligament recovery after ACL repair
Tennis Elbow Alleviates pain, improves grip strength, and enhances
overall function Bone, tendon, ligament, and muscle injuries follow a staged healing
Golf Elbow Reduces symptoms, improves functional outcomes, and process. Platelet-rich plasma (PRP) is utilized in the treatment of soft
speeds up recovery tissue and bone injuries within the musculoskeletal system, particularly
Jumper’s Knee and Provides pain relief, enhances functional outcomes,
in the field of sports medicine. PRP, enriched with growth factors (GFs),
Runner’s Knee and aids in healing
is employed due to the frequent occurrence of tendon, ligament, and
muscle injuries in sports that require prompt and effective interventions
enzymes and endogenous growth factors, promoting cell proliferation for the speedy recovery of athletes. [Table – 1] describes application of
and collagen formation. PRP is synthesized using the athlete’s own PRP in Sports Medicine and Traumatology.
blood. After collecting a blood sample, it is centrifuged to separate its Common sports injuries such as Achilles tendon injuries, runner’s
components into platelets, white blood cells (WBCs), and red blood cells knee, rotator cuff tears, meniscus tears, and cruciate ligament tears are
(RBCs) using differential centrifugation. The concentrated platelets are now being treated using PRP.
then extracted and combined with the remaining plasma before being
injected into the injured area.3 Ultrasound imaging is often employed to 1.4. Achilles tendon
ensure accurate application and placement of the PRP at the site of
injury. The optimal time to create PRP from autogenous whole blood is Due to increased competitiveness, an aging population, and rising
just prior to or at the beginning of surgery when platelets naturally obesity rates, the incidence of Achilles tendon rupture is on the rise.16
accumulate at the surgical site to initiate clotting and healing. This Activities such as sports, dancing, or military service increase the like­
slightly reduces the overall platelet count. Additionally, the platelet lihood of Achilles tendon disease. The majority of severe Achilles tendon
numbers can be further diluted by intravenous fluids during surgery. injuries occur as a result of sports activities, and professional athletes are
PRP remains stable and sterile in an anticoagulated state for up to 8 h particularly prone to Achilles tendon injuries. Approximately 30–50 out
after creation. Therefore, it maintains its efficacy and sterility during of 100 sports-related injuries involve tendon injuries.17 Sports involving
longer procedures as it does when used immediately. Following centri­ activities like jogging, badminton, squash, or training in subzero
fugation, the platelet-rich portion gradually mixes back with the weather put individuals at a higher risk of Achilles tendon injury.18,19
platelet-poor plasma (PPP), leading to a decrease in the platelet con­ A case-control study on athletes showed that compared to conven­
centration of the PRP preparation. Hence, it is crucial to separate the tional repair procedures, there was a quicker return to activity and
PRP from the PPP as soon as possible.4,5 sports, with a more modest increase in tendon cross-sectional area after
18 months. These findings indicate a less fibrotic healing process in the
1.1. Platelet-rich Plasma (PRP) study population.20 In a randomized controlled study by Schepull et al.
where 30 patients with ruptured Achilles tendon underwent surgical
Platelet-rich plasma (PRP) refers to the fraction of autologous blood repair and were administered 10 ml of PRP, no biomechanical effect on
plasma that contains a platelet concentration higher than the baseline. Achilles tendon healing was found.21 Another retrospective study on
The normal range of platelet values in blood varies from 150,000/ cases of acute Achilles tendon rupture that underwent surgical repair
microliter to 350,000/microliter.5 Scientific evidence has already found nearly complete restoration of walking dynamics in both groups at
demonstrated the ability of PRP with a platelet concentration of 1,000, 6 months, regardless of whether PRP was administered over the suture
000/μl to enhance bone and muscle recovery. This platelet concentra­ site. However, the patients who received PRP augmentation showed
tion serves as the operational definition of PRP currently. Lower doses of significant functional gains in ankle motion effectiveness.22 On the
platelets cannot be relied upon to improve wound healing. PRP not only contrary, Keene conducted a multicenter randomized
contains a high quantity of platelets but also includes the complete placebo-controlled trial involving 113 patients with a ruptured Achilles
complement of clotting factors, growth factors (GFs), chemokines, cy­ tendon. These patients received a percutaneous injection of 4 mL of PRP
tokines, and other plasma proteins.6–9 at the center of the tendon gap, preceded by a local anesthetic injection
of 1–2 mL into the surrounding skin, without anesthetizing the tendon
1.2. Mechanism of action itself. Despite laboratory studies not supporting the use of PRP for
tendon healing, the authors claimed that the positive results from PRP
Thrombocytes, also known as platelets, are produced in the bone laboratory research did not translate into observable improvements in
marrow. They are small, nucleated, discoid-shaped cells with the lowest patient rehabilitation from tendon injury.23,24
density among other cellular components, measuring approximately The lack of consistency in PRP preparation techniques and applica­
1.5–3 μm in diameter.10,11 The normal platelet count ranges from 150, tion modalities is the biggest weakness in establishing its consistent ef­
000 to 450,000 platelets per μL.12 Platelets play a crucial role in the ficacy. These factors hinder progress and may lead to incorrect
body as a significant source of growth factors (GFs) and are involved in assumptions about the effectiveness of PRP treatment. The variability of
the clotting process, immune responses, and tissue repair. Throughout tendinopathies, activation, administration, rehabilitation procedures,
the complex process of tissue repair, there are intricate interactions and the type of tendon may all contribute to these contradictory
among connective tissue cells, epithelial cells, immune system cells, and findings.23,25–28
blood cells.
Primarily, platelets are responsible for the clotting process, aiding in 1.5. Rotator cuff
homeostasis through adhesion, activation, and aggregation. When there
is a vascular injury, platelet activation occurs, leading to the release of Rotator cuff tendinopathy is a prevalent and debilitating condition,
substances from platelet granules that promote coagulation.13 Recent accounting for nearly half of the cases of shoulder pain worldwide.29,30

2
P. Patil et al. Journal of Orthopaedic Reports 3 (2024) 100287

It leads to functional impairment, limited range of motion, and difficulty PRP make it a promising treatment modality in sports medicine for
performing overhead tasks, significantly affecting the quality of life for enhancing tissue healing and promoting recovery in these musculo­
patients.31 Rotator cuff tears are the most common shoulder repair is­ skeletal conditions.
sues, but the success rate for large and catastrophic tears following
standard repairs is only about 6–7%.32 Acute rotator cuff tendinopathy 2. Conclusion
is typically caused by direct external force, while chronic rotator cuff
tendinopathy may develop over time due to pressure between the In conclusion, platelet-rich plasma (PRP) has shown great promise as
acromion and rotator cuff.33,34 Although existing treatment modalities a treatment modality for sports injuries. Its regenerative properties and
such as physiotherapy, analgesics, and steroid therapy have shown some ability to promote tissue healing have made it a valuable option for
success, their outcomes vary.35 This is where newer approaches like PRP conditions such as tendon and ligament injuries commonly encountered
come into play, as they are believed to accelerate the healing process in in sports, including Achilles tendon rupture, rotator cuff tears, and
various musculoskeletal conditions.36 In 2013, Rha and colleagues anterior cruciate ligament (ACL) injuries. PRP has also demonstrated
conducted a randomized, single-center study to evaluate the effective­ effectiveness in managing specific sports-related conditions like tennis
ness of PRP injection for treating rotator cuff dysfunction. After a elbow, golf elbow, jumper’s knee, and runner’s knee. While further
six-month follow-up, the PRP group showed better pain relief and research is needed to optimize PRP protocols and understand its
improved freedom of movement. The PRP injection was also found to be mechanisms of action in sports injuries, it holds significant potential for
safe with no observed negative consequences.37 Scarpone conducted an enhancing the recovery and rehabilitation of athletes, ultimately
open-label, prospective study over a four-year and eight-month period, contributing to improved outcomes in the field of sports medicine.
assessing the efficacy of PRP injection using visual analog scale (VAS)
scoring and MRI of the rotator cuffs. The study demonstrated significant Authors contribution
and long-lasting pain relief in individuals with rotator cuff tendinop­
athy. However, the study lacked a control group for comparison, and the PP - Idea, conceptualization, writing draft, approved final draft. MJ –
sample size was small, limiting the ability to predict the response over writing draft and revision of draft, approved final draft. TKS – Super­
time.38 Similarly, Tahririan et al. conducted an open-label, prospective vision, Project Administration, writing draft and revision of draft,
trial to evaluate the effectiveness of ultrasound-guided PRP injection for approved final draft. VT - writing draft and revision of draft, approved
patients with chronic rotator cuff tendinopathy who did not benefit from final draft.
conservative approaches like physiotherapy. The results showed that
PRP improved patients’ functional activities and alleviated pain, eval­
Ethics approval and consent to participate
uated using the constant shoulder score (CSS).39
PRP also has the potential to expedite the recovery of rotator cuff
Not Applicable.
conditions. However, when comparing its effectiveness to corticosteroid
injections or physical therapy, inconsistent evidence was found. The
Consent for publication
variation in PRP preparation methods was cited as one of the main
reasons for the inability to determine its actual effectiveness and the best
Not Applicable.
treatment option among the three.40

1.6. Anterior cruciate ligament Funding

Anterior cruciate ligament (ACL) injury is considered one of the most None.
severe orthopedic injuries in sports and can potentially end a career.41
The current standard treatment for ACL injuries in active individuals Ethical approval
with knee instability is ACL reconstruction (ACLR).42 However, even
though athletes who undergo ACLR generally report good knee function, Not Required.
only 50 % of them are able to return to their previous performance level,
and there is a risk of re-tearing the ACL. The recovery process also re­ Data availability
quires a significant amount of time.43,44
Several studies have supported the use of PRP in the treatment of Not Applicable.
ACL injuries. Animal studies have shown that PRP can accelerate ACL
recovery.45 A study by Mahdi, conducted at a 3-month follow-up after
Declaration of competing interest
ACLR, demonstrated that PRP was a reliable technique that improved
the integration of the graft with the bone.46 Walters found that patients
None.
who underwent ACLR, regardless of whether they received PRP or not,
had similar levels of kneeling discomfort and patellar defect di­
ameters.47 Furthermore, Sözkesen et al. did not recommend the routine Acknowledgements
use of PRP to prevent tunnel growth after ACLR.48
PRP also shown efficacy in treating various musculoskeletal condi­ Sincere thanks to Squad Medicine and Research (SMR) for their help
tions such as tennis elbow, golf elbow, abductor muscle enthesopathy, and guidance.
jumper’s knee, and runner’s knee.49–55 In tennis elbow, PRP injections
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