Equis ISSN 2398-2977

Platelet-rich plasma therapy

Synonym(s): PRP therapy

Contributor(s): Graham Munroe

Introduction

  • Platelet-rich plasma (PRP) is an autologous biologic therapy obtained from the serum of a venous blood sample   Blood: collection  taken from the horse being treated.
  • There are some commercially available gravity filtration production systems that can be used "horse-side".
  • PRP contains platelets in significantly greater numbers (3-5x) than whole blood. There is yet no proven optimal concentration.
  • Platelets contain growth factors.
  • Scientific evidence indicates that PRP can provide a scaffold and growth factor concentrate (When activated) to enhance the cellular repair of musculoskeletal lesions.

Indications

  •  Following an acute traumatic injury to musculoskeletal tissues, particularly tendon and ligament injuries. It is commonly used in treating core-like acute lesions in the digital flexor tendons and suspensory ligament, often as a single percutaneous intralesional injection under ultrasound guidance. Many other uses are reported anecdotally for a variety of soft tissue orthopedic injuries.
  • Has been used in conjunction with biosynthetic scaffolds in osteochondral repair in humans.
  • Particularly useful in sport horses where positive drug tests for pharmaceuticals need to be avoided during the active season.
  • There are anecdotal reports of its use in equine joint disease either intra-operatively by arthroscopic-guided injection of intra-articular ligaments or placement of PRP gels into chondral defects, or post-operatively by single or multiple intra-articular injections as a less specific treatment for cartilage/soft tissue injuries or osteoarthritis.
  • PRP gel has been used to enhance surgical wound healing.

Advantages

  • Autologous nature.
  • Non-invasive collection procedure.
  • Rapid preparation if using a filtration system which can be carried out "horse-side".
  • Less expensive than IRAP.

Disadvantages

  • The lack of standardized protocol for PRP production can lead to inconsistent results and the platelet concentration can vary widely between different preparation systems.
  • The therapeutic effect is still not completely understood: platelet number, growth factor concentration, or something else may be contributory.
  • Optimal administration protocols have not been determined for its use in soft tissues or synovial structures.
  • Administration of PRP may promote scarring and fibrosis of a healing lesions rather than increasing the speed and quality of repair in certain cases. It is worth noting that PRP does not contain any source of cells.
  • Leukocytes are almost always present in PRP, to varying degrees. Their presence can cause inflammatory reaction at the injection site and degradation of collagen matrix, which are detrimental to healing.

Print-off the Owner factsheet on Platelet rich plasma (PRP) therapy to give to your clients.

Action

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Production

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

PRP storage and activation

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Administration

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Aftercare

This article is available in full to registered subscribers

Sign up now to purchase a 30 day trial, or Login

Further Reading

Publications

Refereed papers
  • Recent references fromPubMedandVetMedResource.
  • Textor J A & Tablin F (2013)Intra-articular use of a platelet-rich product in normal horses: clinical signs and cytologic responses. Vet Surg42(5), 499-510PubMed.
  • Bosch G et al(2011)The effect of platelet-rich plasma on the neovascularization of surgically created equine superficial digital flexor tendon lesions. Scand J Med Sci Sports21(4), 554-561PubMed.
  • McLellan J & Plevin S (2011)Evidence-based clinical question: does it matter which platelet-rich plasma we use? Equine Vet Educ23(2), 101-104. 
  • Textor J (2011)Autologous biological treatment for equine musculoskeletal injuries: platelet-rich plasma and IL-1 receptor antagonist protein. Vet Clin Equine27(2), 275-298PubMed.
  • DeRossi R et al(2009)Effects of platelet-rich plasma gel on skin healing in surgical wound in horses. Acta Cir Bras24(4), 276-281PubMed.
  • Fortier L A & Smith R K W (2008)Regenerative medicine for tendinous and ligamentous injuries of sport horses. Vet Clin North Am Equine Pract24, 191-201PubMed.
  • Waselau M, Sutter W W, Genovese R L & Bertone A L (2008)Intralesional injection of platelet-rich plasma followed by controlled exercise for treatment of midbody suspensory ligament desmitis in Standardbred racehorses. JAVMA232(10), 1515-1520PubMed


ADDED