platelet rich plasma

This scoping review aims to evaluate the safety and efficacy of orthobiologics in the treatment of Greater Trochanteric Pain Syndrome (GTPS), with a focus on pain relief, functional improvement, and quality of life.

We conducted a comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, Scopus, Google Scholar, and CINAHL for studies published from January 1, 2000, to March 20, 2024. Eligible studies included case series, cohort studies, case-control studies, and randomized controlled trials (RCTs) that investigated the use of orthobiologics for GTPS. The primary outcomes assessed were pain, function, and quality of life. The quality of the studies was evaluated using the JADAD scale, the Cochrane Risk of Bias Tool, and the MINORS score.

The review included 19 studies involving a total of 811 participants. Platelet-rich plasma (PRP) was found to significantly reduce pain, as measured by the VAS scores, and to improve functional outcomes including the modified Harris Hip Score (mHHS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores. These findings suggest that PRP may be an effective treatment for GTPS. The studies reported minimal side effects that were generally mild and transient.

PRP and other orthobiologic treatments show promise in managing GTPS, showing good safety profiles and potential benefits. However, further high-quality RCTs are necessary to confirm long-term efficacy and to establish standardized treatment protocols. Level of evidence: II

Melasma, characterized by irregular skin hyperpigmentation, presents a therapeutic challenge with limited universal solutions. Platelet-rich plasma (PRP) and Tranexamic Acid (TXA), coupled with microneedling, offer promising avenues for treatment. This clinical trial sought to compare the efficacy and adverse effects of microneedling with PRP versus TXA in managing melasma.

The study was a single-blind, randomized controlled trial from May 2022 to Apr 2023 and enrolled 23 female melasma patients. Using the coin toss method, patients were randomly assigned to receive microneedling with PRP on one side and microneedling with TXA on the other. Evaluation parameters included Melasma Area and Severity Index (MASI) scores, melasma improvement grading, patient satisfaction, and treatment-related side effects, monitored over three sessions at 3-week intervals.

Both microneedling approaches demonstrated effectiveness, with the PRP group exhibiting significantly lower MASI scores at the 6th and 9th wk. However, no significant distinctions were observed in improvement grading or patient satisfaction between the PRP and TXA groups. Side effects were minimal, limited to transient burning and mild pain during the procedure.

Microneedling with PRP and TXA emerged as a safe and effective treatment for melasma. While the PRP group showed potential superiority in MASI scores, comprehensive considerations, including patient preferences and long-term outcomes, are crucial. Larger, multi-center studies with extended follow-up periods are warranted for a more nuanced understanding of these treatments in melasma management.

Platelet-rich plasma (PRP) contains multiple growth hormones that may stimulate tissue repair. We aimed to assess PRP’s efficacy and explore possible mechanisms using the intervertebral disc degeneration (IDD) model. 

A total of 48 male Sprague-Dawley (SD) rats were randomly divided into three groups: sham, IDD+PBS, and IDD+PRP (n=16, respectively). IL-1β (10 ng/ml) was used to establish a humanized IDD model in human lumbar nucleus pulposus (NP) tissues from 36 patients with degenerative disc disease. These NP cells were randomly divided into three groups: sham, IDD+PBS, and IDD+PRP (n=12, respectively). RT-PCR and western blot were used to detect the expression of aggrecan, collagen II, IL-1β, IL-6, TNF-α, Bcl-2, cleaved-Caspase 3, Bax and Akt/mTOR/p70S6K signaling pathway. A related assay kit was used to detect MDA, SOD, and GSH.

PRP affected the expression of aggrecan, collagen II, IL-1β, IL-6, TNF-α, MDA, SOD, GSH, Bcl-2, cleaved-Caspase 3, and Bax in IDD rats. Compared with the IDD+PBS group, the expression of p-mTOR, p-p70/S6K, and p-Akt was much lower in the rat IDD+PRP group (P<0.05). Similarly, with PRP treatment in the humanized IDD model, the expression of p-mTOR, p-p70/S6K, and p-Akt was also inhibited.

PRP may be a potential therapy for IDD via the mTOR signaling pathway in regulating and affecting extracellular matrix degradation, inflammatory factors, oxidative stress, and apoptosis.

The purpose of this in brief article was to determine the current role of intraarticular injections of hyaluronic acid (HA) and platelet-rich plasma (PRP) for the treatment of painful KOA. It has been reported that the average duration of effectiveness (pain relief) of one injection of extended-release HA is around one year. Kellgren-Lawrence grade (I-II versus III-IV), male gender, and older age are associated with a longer duration of effectiveness. Cartilage degeneration might be improved with a higher number of injections of HA. Intraarticular injections of HA alleviate pain, function, and diminish non-steroidal anti-inflammatory drugs (NSAIDs) consumption. In addition, several studies have indicated that the combination of HA and PRP is more effective than HA alone. Finally, other studies seemed to demonstrate that PRP was more effective than HA.        Level of evidence: III

Sacroiliac joint (SIJ) pain poses a significant burden on patients and the healthcare system. Due to its potential for tissue regeneration, minimally invasive administration, and affordability, platelet-rich plasma (PRP) has recently gained attention in the management of SIJ pain. Although PRP is widely used for musculoskeletal conditions, there is limited evidence regarding its application in SIJ pain.

This study aims to assess the impact of PRP injections in patients with chronic SIJ pain that is unresponsive to conservative treatments.

This study is a single-arm, open-label clinical trial. Patients aged between 30 and 80 years with chronic SIJ pain were included. Platelet-rich plasma was prepared from autologous blood and injected into the SIJ under ultrasound (US) guidance. Pain intensity was assessed using the Numeric Rating Scale (NRS), and functional disability was measured using the Modified Oswestry Disability Index (MODI) before the intervention, as well as one month and three months post-injection. Statistical analysis was performed using repeated measures ANOVA in SPSS version 23 to evaluate changes over time.

A total of 16 patients were included in the study. At the one-month follow-up, the mean pain intensity dropped to 5.19 ± 2.66, followed by a slight increase to 5.75 ± 2.54 at the three-month follow-up. The mean MODI score was 67.00 ± 8.42 at baseline, improving to 46.75 ± 21.46 at one month, and slightly increasing to 50.50 ± 19.98 at three months. The overall changes in pain intensity and disability index over the three months were statistically significant (P < 0.001). No significant adverse events were reported.

Platelet-rich plasma injection resulted in significant pain reduction and functional improvement for chronic SIJ pain over three months, suggesting its potential as a minimally invasive therapeutic alternative for patients who are unresponsive to conventional therapies. While PRP appears to be a safe modality for SIJ pain management, further studies with larger sample sizes and extended follow-ups are needed to explore its effectiveness and safety.

Reducing orthodontic treatment duration is a significant concern for both patients and clinicians, as prolonged treatments can lead to complications like dental caries, root resorption, and decreased patient compliance. This study aims to compare the effectiveness of two minimally invasive techniques—Piezocision and platelet-rich plasma (PRP) injection in accelerating orthodontic tooth movement during space closure in patients with bimaxillary protrusion.

Sixteen patients diagnosed with Angle's Class I bimaxillary protrusion requiring extraction of first premolars were randomly assigned to two groups. Group A (n = 8) underwent Piezocision-assisted orthodontic treatment, while Group B (n = 8) received submucosal PRP injections. In both groups, one side of the maxillary arch served as the experimental side, and the contralateral side served as the control. Measurements of space closure were taken at the initiation of retraction (T0) and after 90 days (T1). Paired t-test, independent t-test, ANOVA and post hoc Tukey test were used for statistical analysis. P-value<0.05 was considered as significant.

There were significant differences in mean difference of space closure between Piezocision experimental group and Piezocision controls(p=0.003);also, there were significant differences between PRP experimental group and PRP controls (p=0.000). In addition, this study did not show any significant differences in the mean difference of space closure between  Piezocision experimental and PRP experimental groups(p=0.252).

Piezocision and submucosal injection of PRP could increase the rate of space closure. There is no difference between Piezocision and PRP in rate of space closure.

Recurrent implantation failure (RIF) can be explained mainly by improper crosstalk between the embryo and endometrium. The T-helper1/T-helper2 profile balance influences effective embryo implantation. Endometrial immunomodulation via intrauterine injection of activated peripheral blood mononuclear cells (PBMCs) or autologous platelet-rich plasma (PRP) is a potentially efficient treatment option.

This study aims to examine the biochemical and clinical pregnancies resulting from the intrauterine administering of activated PBMCs and PRP in RIF women.

This randomized clinical trial study was done in the Rooya Infertility Treatment Center, Qom, Iran from November 2022 to April 2024. 96 women with at least 2 RIFs were randomized into control, PBMC, and PRP groups. Briefly, 3 ml of blood sample was collected and PBMCs were isolated using Ficoll separation solution, and cultured for 72 hr. PRP was separated from 10 ml of peripheral blood through centrifugation. 2 days before embryo transfer PBMCs or PRP were transferred into the endometrial cavity.

Except for the duration of infertility, which was higher in the PBMC group, all other baseline characteristics were not statistically different. Moreover, a significantly higher rate of biochemical pregnancy was observed in the PRP (10/32) and PBMC (12/32) groups compared to the control (3/32) (p = 0.027), while the rate of clinical pregnancy was only significantly higher in the PBMC group (10/32) than in the control group (2/32) (p = 0.038).

Neither PBMC nor PRP interventions exhibited a substantial advantage over one another regarding biochemical and clinical pregnancy rates.

The antimicrobial characteristics of biological products are fundamental in medicine due to their ability to treat microbial infections. This research aimed to assess and compare the antimicrobial properties of various platelet concentrates, including platelet-rich plasma (PRP), plateletrich fibrin (PRF), plasma-rich in growth factor (PRGF), and conditioned medium (CM) derived from adipose-derived mesenchymal stem cells (ADSCs) obtained from rats.

This experimental study obtained blood-derived products from 50 healthy Wistar rats. After obtaining 5 mL blood sample from each rat via cardiac puncture, it was used to prepare PRGF (group 1), PRP (group 2), and PRF (group 3). For the preparation of PRGF, 0.9% mL of 3.8% sodium citrate was used for every 8.1 mL of the blood. The centrifugal speed was 2500 rpm for 8 min. For the preparation of PRP, the centrifugal speed was 1800 rpm for 10 min and then 3600 rpm for 10 min. PRF was obtained with a centrifugation method of 3000 rpm for 10 min immediately after blood collection, and no anticoagulant was used. Furthermore, 2–4 g abdominal adipose tissue from each rat was used to isolate and culture ADSCs. Then, the CM derived from ADSCs was obtained (group 4). Bacterial strains were grown in blood agar medium and were separately treated with these four groups for 24 h at 37 °C.

In this study, PRP stopped the growth of the Staphylococcus epidermidis bacterium, with a clear zone of inhibition around the PRP. This blood-derived product also stopped the growth of Escherichia coli, while the PRF prevented the growth of three bacteria: Klebsiella pneumoniae, Staphylococcus aureus, and Pseudomonas aeruginosa. PRGF and CM showed no antibacterial activity against these bacterial strains.

PRP and PRF can create antimicrobial conditions in vitro due to their secretion of growth factors like platelet factor 4, fibrinopeptide A, and fibrinopeptide B. They can equally be used as treatment options to ameliorate microbial infections,although preclinical and clinical trials are necessary to understand their characteristics and activities better.

Statement of the Problem: 

Treatment of immature necrotic teeth is a problematic situation. Conventional root canal therapy is challenging and leaves a weak, fragile and undeveloped tooth for lifetime.

This review was aimed to assess the outcome of available randomized clinical tr-ials (RCTs) on the efficacy of platelet concentrates (PC) in dentine-pulp complex regeneration.

An electronic search was conducted on MEDLINE, EMBASE, Cochrane, and Google scholar databases. A further manual search was performed on the list of related articles in order to ensure inclusion of potentially missed articles in earlier electronic search. Those proved RCTs matched with the standard criteria were included following an initial assessment of abstracts and the text independently by the reviewers.

From the total 602 harvested articles, only 13 met the criteria and were evaluated with 11 having parallel design and 2 split mouth. Only one study featured low risk of bias, while three had moderate risk and the rest were at high risk of bias. Six studies had used platelet rich plasma (PRP), 4 employed platelet rich fibrin (PRF), one utilized injectable platelet rich fibrin (I-PRF), and three used both PRF and PRP for their experimental groups while blood clot (BC) was used as the control group for all. The success rate was reported at 87.3% judged by the absence of pathologic signs and symptoms.

Dentin wall thickening, root lengthening and apex closure were higher in PC groups, however, these differences were not statistically significant in reported studies. It can be concluded that PCs promote the pulp tissue revitalization and continuation of root development. However, a consensus on its potency for true pulp regeneration is yet to be reached.

Knee osteoarthritis (OA) is the most common reason for orthopedic secondary care referral. And it is one of the main causes of disability in adults worldwide. It is estimated to affect between 10 to 25% of patients over the age of 60. Intra-articular corticosteroid injection (IA CS) and physical therapy were the two choices in an attempt to provide symptomatic management or deferred surgery. There is a growing trend is intra-articular platelet-rich plasma (IA PRP) injection to reduce pain and improve function in OA patients. PRP is divided into two types: leukocyte-poor platelet-rich plasma (LP-PRP) and leukocyte-rich platelet-rich plasma (LR-PRP). It was shown that LR-PRP increases pro-inflammatory factors and also decreases anti-catabolic mediators, and LP-PRP has the opposite aspect.

In our research 40 patients were divided into two equal groups, IA corticosteroid and leukocyte-poor platelet-rich plasma (LP-PRP) 40 cc of blood from the basilic vein of the upper limb is used with two step centrifugation. The final samples were 4 millilitres product injected intra-articular. group two (corticosteroid (CS)) received an intra-articular injection of triamcinolone acetate (Kenalog) 40 mg/ml along with 4 ml of lidocaine 0.02% (Abureyhan Co.) for a total of 5 ml. The needle used is a 22-gauge pencil-point Quincke needle (Dr. Japan Co, Ltd), which is performed with the Sonosite Edge II ultrasound guide and in an anterior-lateral manner in the knee joint. Pain was assessed on a visual analogue scale (VAS range 0-10 points) before, one week, one month, two month and 3 months after the operation. The WOMAC questionnaire was also filled before injection and three months following injection and other variables were examined.

There were no significant differences between the groups across all the baseline parameters including age, sex, body mass index and comorbidities including high blood pressure, diabetes and smoking. Both injection groups were effective in reducing patients' pain from one week to three months after injection. The level of pain in the first week after injection was significantly lower in the corticosteroid group than in the PRP group. In the first month and the third month after the injection, the pain reduction according to mean scores of VAS was the same in both groups.

In short, one injection of PRP can reduce the pain of patients with osteoarthritis of the knee as much as corticosteroids during a three-month treatment process. Considering the possible side effects of corticosteroids, this alternative treatment can be considered with further investigation.

To assess the efficacy of autologous platelet‑rich plasma (PRP) injections in suprachoroidal space and subtenon space in cases of retinitis pigmentosa, which is a genetic disease, leading to gradual loss of vision. Till date, no treatment is available.

Seventy-eight eyes of 39 patients of retinitis pigmentosa having visual acuity ranging from reading of Early Treatment Diabetic Retinopathy Study (ETDRS) chart from 1 m onward to patients who were not able to read the ETDRS chart but whose visual acuity ranged from finger count close to face to <1 m were included in the study. The left and right eyes of each patient were randomized as the intervention eye and control eye. 0.2 mL of autologous PRP was injected in suprachoroidal space and 0.5 mL of PRP was injected in subtenon space of the intervention eye taking aseptic precautions. Injections were repeated at 15-day intervals up to 3 injections.

Majority of patients were in the age group of 18–30 years(20 cases) followed by 31–45 years(13 cases) and more than 45 years(6 cases). Intervention eyes showed a statistically significant improvement in visual acuity and multifocal electroretinography (mfERG). Improvement was noted in amplitude density latency and in ring ratio of mfERG. There was a significant improvement in best-corrected visual acuity (BCVA). However, no improvement in mfERG or BCVA was observed in the control group.

Gene therapy may be the ultimate cure for retinitis pigmentosa, but it is unaffordable for many patients due to its high cost. PRP may be recognized as a modality to improve vision and stop further deterioration, especially in cases where functional vision is preserved. Negligible treatment costs and affordability will give power to economically disadvantaged patients.

 Chronic wounds, which are persistent disruptions in skin integrity, represent a significant global health challenge. Various types of ulcers, including venous, arterial, diabetic, pressure, and traumatic ulcers, contribute to personal, professional, and societal burdens. Autologous platelet-rich plasma (PRP) has emerged as a promising therapeutic option by leveraging the growth factors in platelets for tissue regeneration.

 This prospective study, conducted from December 2021 to December 2023, enrolled 10 patients with chronic ulcers. The PRP gel was prepared through a systematic process that included blood collection, centrifugation, and activation.

 The study included 8 males and 2 females, with an average age of 48.8 years. Ulcer etiologies encompassed diabetic foot ulcers, arterial ulcers, and venous ulcers, among others. The initial average surface area of the ulcers was 18.7 cm2. Complete healing was observed in a case of Buerger's disease, while very good healing was achieved in one diabetic foot ulcer, one venous ulcer, and another case of Buerger's disease. Moderate healing was noted in five cases of arterial ulcers, and poor healing was observed in one case of prolidase deficiency. The average surface area post-treatment for all patients was reduced to 8.05 cm2, with no reported pain or adverse effects.

 Platelet-rich plasma gel emerges as a promising alternative to traditional treatments, potentially lessening the overall impact on healthcare resources and enhancing the quality of life for individuals with chronic ulcers.

Finding the most effective way to improve implantation rate in women who are receiving assisted reproductive technology treatment is still a challenge.

This study aimed to assess the pregnancy outcomes of intrauterine platelet-rich plasma (PRP) therapy in women with a history of at least 2 implantation failures.

In this retrospective cohort study, data of 852 women who were candidates for frozen-thawed embryo transfer was extracted from their medical records from April 2017 to September 2021 at Yazd Reproductive Sciences Institute, Yazd, Iran. Of these, 432 received intrauterine PRP treatment 48 hr before transfer (PRP group), and the results of the pregnancy outcomes compared with 420 of the control group who did not receive the treatment before transfer.

Pregnancy outcomes, including chemical, clinical, ongoing pregnancy, and live birth rate were statistically significant in the PRP group (p < 0.001). However, when categorized according to the implantation history, this significant improvement in all 4 was only seen in women with at least 2 prior implantation failures. In women with a history of only one implantation failure, PRP therapy significantly improved the ongoing pregnancy and live birth rate (19.5%, p = 0.04). Also, in women who received donor eggs and had repeated implantation failure, PRP improved pregnancy outcomes clinically but not statistically (p = 0.15).

PRP seems to be effective in improving the pregnancy rate in women with a history of 2 or more implantation failures and also shows an increase in the live birth rate in women with only one implantation failure.

Platelet-rich plasma (PRP) therapy has been shown to enhance tissue regeneration by expressing severalcytokines and growth factors (GFs). This study investigated the effect of intrauterine infusion of PRP as a noninvasiveautologous GF on pregnancy outcomes in women with repeated implantation failure. This randomized clinical trial was conducted to compare the pregnancy rates between twogroups of women who were candidates for the frozen-thawed embryo transfer with a history of two or more implantationfailures. The PRP group (n=33) was treated with hormone replacement therapy+0.5 cc to 1 cc PRP infusedinto the uterine cavity two days before the embryo transfer. The control group (n=33) was only treated with hormonereplacement therapy. The endometrial preparation process was done similarly in both groups. The chemical, clinical,and ongoing pregnancy, and implantation rates were compared between the two groups. Our results showed that the chemical pregnancy rate was not statistically higher in the PRP group in comparisonwith the control group (36.4 vs. 24.2%). In addition, the clinical pregnancy, ongoing pregnancy, and implantationrates were higher in the PRP group than the control group; however, the difference between the two groups was notstatistically significant. Administration of intrauterine PRP before embryo transfer in women with repeated implantation failure(RIF) does not affect assisted reproductive technology (ART) outcomes (registration number: IRCT2016090728950N3).

Many people were affected by COVID-19 in its severe form. Some intercurrences are still emerging. We here report two cases of COVID-related osteonecrosis of the jaws (CRONJ). Two retrospective cases were admitted into Imam Reza Hospital, Mashhad, Iran with suspected CRONJ. One patient escaped from hospital while the other showed a positive result after our proposed treatment. A new aftermath to COVID-19 infections is emerging. Maxillofacial and orthopedic surgeons should be aware of this situation. CRONJ should be on the suspect list in patients with COVID-19. Measures that are useful in the treatment carried out, as well as some measures recommended in the literature, were discussed. Surgical treatment of CRONJ appears to be an effective alternative, especially in the more aggressive cases.