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Selected Publication:
Sadoghi, P.
The Role of Platelet-rich Plasma (PRP) in the Treatment of Athletes at Risk of Tendinosis and Tendinopathy
Doktoratsstudium der Medizinischen Wissenschaft; Humanmedizin; [ Dissertation ] Medical University of Graz; 2013. pp.96.
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- Authors Med Uni Graz:
- Sadoghi Patrick
- Advisor:
- Kastner Norbert
- Leithner Andreas
- Singer Georg
- Altmetrics:
- Abstract:
- The aim of this PhD thesis was to assess the impact of platelet-rich plasma (PRP) on athletes at risk of tendinosis with a special focus on the Achilles tendon and rotator cuff. We therefore evaluated existing studies on animal and human trials with a focus on the Achilles tendon to raise a conclusion in a meta-analysis, and, as data on the human rotator cuff was not sufficient to get pooled, created an in vitro investigation of PRP on the human rotator cuff. In order to systematically review the current in-vivo evidence for the use of platelet-concentrates (PRP) in the treatment of Achilles tendinopathy and Achilles tendon a systematic search of PubMed, CINAHL, EMBASE, and CDSR was performed for animal and human studies using the terms ‘‘Achilles tendon and platelet.’’ The systematic search revealed a total of 149 papers. After excluding duplicates and cases of overlapping data, studies not focusing on in vivo evidence in terms of treatment or outcome, studies without any intervention, studies with unacceptable high attrition, one Chinese and one Swedish study, the remaining 14 manuscripts were included. The key finding of our study is evidence in support of a statistically significant effect of platelet concentrates in the treatment of Achilles tendon ruptures in vivo in animal models and human application, consistent with a medium to large sized effect. This effect is most likely attributable to fastened and enhanced scar tissue maturation. There was no evidence for a beneficial effect of platelets in Achilles tendinopathy. In order to assess the in vitro effect of platelet-rich plasma (PRP) on biological activity of the human rotator cuff fibroblasts and to describe the optimal dose-response to maximize cellular stimulation while reducing potential risk, rotator cuff (RC) fibroblasts of n = 6 patients (mean age of 65.2 years) undergoing arthroscopic cuff tear reconstruction were cultured in vitro for 21 days and stimulated with PRP in three different concentrations (1-, 5-, and 10-fold). Samples were obtained for DNA and glycosaminoglycan (GAG) measurement at 1, 7, 14, and 21 days. The biological outcomes were regressed on the PRP concentration. The application of PRP significantly influenced the fibroblast proliferation and activity of the human rotator cuff with elevated GAG and DNA levels. The dosage of PRP had the significantly highest impact on this proliferation using a onefold or fivefold application. These findings showed that PRP has a significant effect on fibroblast proliferation of the human rotator cuff in vitro with an optimal benefit using a onefold or fivefold PRP concentration. This study justifies further in vivo investigations using PRP at the human rotator cuff. As an overall conclusion, PRP might offer interesting solutions in tissue engineering, in general. However, it is too early to recommend it in clinical application as PRP has not been definitely proven to be beneficial in clinical settings yet.