Platelet-Rich Plasma Injections for Wound Healing and Tissue Rejuvenation: A Review of Clinical Effectiveness, Cost-Effectiveness and Guidelines

Platelet rich plasma (PRP) injections have been used in the context of musculoskeletal soft tissue injuries, bone fractures, orthopaedic surgery, osteoarthritis, bone defects, joint degeneration, wound care, and other indications. Alternative treatment approaches in these contexts include physiotherapy, glucocorticoid injections, or non-steroidal antiinflammatory medications. Administration of a supraphysiological concentration of platelets allows targeted delivery of a high "dose" of growth factors, cytokines, chemokines and other bioactive proteins to the target tissue. The use of autologous PRP has become popular due to its putative effects on tissue repair and regeneration. PRP has been defined as an autologous plasma derivative in which the concentration of platelets is above baseline. Various classification methods have been proposed that provide more specific categories and are based on criteria such as platelet concentration, leukocyte content, red blood cell content, and the method of exogenous activation of platelets (e.g. by collagen, thrombin, or calcium). Standards for reporting these parameters have not been universally applied in PRP research studies and therefore may affect study interpretation. In addition, there are many commercially available devices for PRP preparation. There is also a wide variation of administration practices that vary by number of injections, volume of injection and location of injections.