Platelet-rich Plasma in Orthopedics: Unraveling Cellular Mechanisms, Therapeutic Potential, and Limitations

Abstract

The growing interest in autologous biological therapies, such as Platelet-Rich Plasma (PRP), within orthopedic surgery and sports medicine, necessitates refined strategies for post-surgical tissue repair. Despite technological advancements, the proliferation of PRP preparation devices has raised concerns about preparation quality consistency. The absence of consensus on standardization and condition-specific formulations contributes to conflicting outcomes in the literature. Moreover, the potential of personalized treatment protocols, platelet dosage optimization, and PRP’s angiogenic, antimicrobial, and analgesic properties in orthopedic surgery remains underexplored. This review delves into recent advancements in PRP preparation techniques and therapeutic effects, drawing from published data on its applications in orthopedic surgery for tendon injuries, bone repair, spinal fusion, and major joint replacements. Despite promising preclinical study results, clinical trials have shown varying efficacy compared to traditional repair methods. Mechanisms underlying PRP’s actions, including its impact on tendon fibroblasts and macrophage polarization, are scrutinized. While PRP elicits an inflammatory response in tendon fibroblasts, its effect on macrophage polarization remains ambiguous. Additionally, inconclusive findings from studies on PRP’s effectiveness in shoulder surgery underscore the need for standardized protocols and further investigation due to challenges like preparation discrepancies and application techniques. This review focusing on influence on healing quality and pace.