Article Authors: Gordon Slater| Tandose Sambo
Over the past two decades, extensive research all over the world has shown that laughter has a positive impact on various systems of the body. Most noteworthy is laughter’s ability to unwind the negative effects of stress: the catalyst for many of our health problems. – Dr Madan Kataria, Laugh For No Reason
Within the fields of orthopaedics and sports medicine, traditional medicinal practices are being utilised along with more unconventional methods of treatment, that utilise the body’s own mechanisms to optimise the healing of an individual. The fusion of the two methodologies yields a synergistic outcome. As the potential of biologics continues to emerge, the future of the utilisation of these therapies will continue to dominate. One such therapy is the utilisation of platelet rich plasma (PRP). The applications of PRP are starting to emerge within the orthopaedic realm. As an enhancer of cartilage repair and regeneration, PRP utilisation is becoming a standard in orthopaedic care.
While initial phases of the understanding of the mechanisms of action of PRP are still being elucidated, there is a current emergence of the various interactions that enable PRP to achieve its objectives of healing and regeneration in a human biological system. As higher quality medical information is available, the proof of PRP effectiveness is actually being validated. Articular cartilage injury is one of those aspects of orthopaedic care that has benefited from the applications of PRP. This condition develops during the degenerative process that is induced by osteoarthritis (OA).
During the progression of OA, there are various mechanisms at play that result in the altering of various biological parameters. As a result, the relevant regulation of compounds such as cytokines and various enzymes is affected. PRP influences and counteracts these conditions, and ultimately results in the restoration of the appropriate balance of these internal factors. The joint regenerates as the healing mechanisms reach their peak. As pre-clinical studies and clinical trials are optimised in terms of technology and focus, the effectiveness of PRP and its direct mechanisms of action will be well known.
OSTEOARTHRITIS
Osteoarthritis affects patients knees mostly, and is attributed to the loss of articular cartilage. Affecting up to 4% of the globe at any one time, there is always a need to ensure that the healing of this condition can be optimised. With longevity on the rise, mobility of the human population will be one thing that persons will want to factor into their quality of life. Biologic utilisation in the treatment of OA aims to minimize the inflammatory processes that take place during arthritis that cause the articular cartilage to be affected. To ensure that articular cartilage is restored, it will be important to ensure that critical parameters are sustained. These are the anabolic and catabolic factors. PRP does well in the balancing of these two.
PRP IMPACT ON OA
PRP is obtained via centrifugal processes, and involves the extraction of the platelets from the bloodstream. Within these concentrated solutions of PRP, are the various healing components that will facilitate the restoration of the articular cartilage. This includes the increased concentration of growth factors and proteins. When concentrated in a location such as the knee, and injected to a healing site, these components will then enhance the regeneration of the tissues. Articular cartilage is degenerated in the OA progression, while PRP counteracts its mechanism of action via: inhibiting the catabolic cytokines of IL-1β and TNF-α, and by promoting factors associated with cartilage matrix synthesis including fibroblast growth factor, transforming growth factor-β (TGF-β), and others.
As a modulator of the inflammatory processes, PRP has proven its effectiveness in controlling the process. Further details of the mechanisms of action are outlined in the second reference of this article. The process is a very detailed multi-step regulatory process that involves a series of interactions between the PRP and various elements in the cellular matrix.
PRP is incorporated into a multitude of treatment strategies in the treatment of OA. These include operational utilization via grafting mechanism, or the incorporation of the treatment in a non-operative manner via injections. As the demand for biologic treatment increases, the PRP methodology will be a factor that will be increasingly utilized in the minimization of the impacts of OA. As a regenerative therapy, it will be one of those treatments that has dual purposes. Various pharmaceutical preparations modes of PRP are under study, and the findings and efficacy being documented for future use. These include preparations such as fibrin glue or gel, inactivated leukocyte-poor PRP, and leukocyte-rich PRP. The preparations have been tested in both a pre-clinical and clinical application.
Clinical Applications of PRP have been a medical focus for the past twenty years and continue to be a benefit to the treatment of OA. As varieties of PRP preparations have become standard and are proving their efficacy, the utilization will only go up. As PRP aims to restore the articular cartilage via mitigating and balancing the inflammatory and catabolic environments in a site, the hope is that a deeper understanding of how this occurs will be finalized during studies.
The future of PRP utilization is definitely one that will be a focus for many more decades to come. Once the establishment of robust clinical trials and improvement in reporting standards is established, the appropriate escalation to clinical trials will be facilitated.
Article References:
- The Role of Platelet-Rich Plasma in Cartilage Pathology: An Updated Systematic Review of the Basic Science Evidence: https://bit.ly/3lugXAC
- Platelet-Rich Plasma and Cartilage Repair: https://bit.ly/3nDJx4