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Platelet-rich plasma therapy

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Synonym(s): PRP therapy


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.
  • 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. PRP 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 for a variety of soft tissue orthopedic injuries.
  • Has been used in conjunction with biosynthetic scaffolds in osteochondral repair in humans.
  • There are 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 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".

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.
  • 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 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

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Production

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PRP storage and activation

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Administration

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Aftercare

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Fukuda K et al (2020) Optimal activation methods for maximizing the concentrations of platelet-derived growth factor-BB and transforming growth factor-β1 in equine platelet-rich plasma. J Vet Med Sci PubMed.
  • Radtke A V, Goodale M B & Fortier L A (2020) Platelet and leukocyte concentration in equine autologous conditioned plasma are inversely distributed by layer and are not affected by centrifugation rate. Front Vet Sci 12 (7), 173 PubMed
  • Garbin L C & Olver C S (2020) Platelet-rich products and their application to osteoarthritis. J Equine Vet Sci 86 PubMed
  • McClain A K & McCarrel T M (2019) The effect of four different freezing conditions and time in frozen storage on the concentration of commonly measured growth factors and enzymes in equine platelet-rich plasma over six months. BMC Vet Res 15 (1), 292 PubMed
  • Machado T S L et al (2019) Effects of blood-derived products and sodium hyaluronate on equine synovial fluid cells and on synovial fluid from osteochondrotic joints of horses after arthroscopy and administration of treatment. Am J Vet Res 80 (7), 646-656 PubMed.
  • Seabaugh K A, Thoresen M & Giguère S (2017) Extracorporeal shockwave therapy increases growth factor release from equine platelet-rich plasma in vitro. Front Vet Sci 7 (4), 205 PubMed.
  • Witte S et al (2016) Comparison of treatment outcomes for superficial digital flexor tendonitis in National Hunt racehorses. Vet J 216, 157-63 PubMed.
  • Geburek F et al (2016) Effect of intralesional platelet-rich plasma (PRP) treatment on clinical and ultrasonographic parameters in equine naturally occurring superficial digital flexor tendinopathies - a randomized prospective controlled clinical trial. BMC Vet Res 12 (1), 191 PubMed.
  • Mirza M H et al (2016) Gait changes vary among horses with naturally occurring osteoarthritis following intra-articular administration of autologous platelet-rich plasma. Front Vet Sci 13 (3), 29 PubMed.
  • Moraes A P et al (2015) Short- and long-term effects of platelet-rich plasma upon healthy equine joints: Clinical and laboratory aspects. Can Vet J 56 (8), 831-8 PubMed.
  • O'Shea C M, Werre S R & Dahlgren L A (2015) Comparison of platelet counting technologies in equine platelet concentrates. Vet Surg 44 (3), 304-13 PubMed.
  • Textor J A & Tablin F (2013) Intra-articular use of a platelet-rich product in normal horses: clinical signs and cytologic responses. Vet Surg 42 (5), 499-510 PubMed.
  • 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 Sports 21 (4), 554-561 PubMed.
  • McLellan J & Plevin S (2011) Evidence-based clinical question: does it matter which platelet-rich plasma we use? Equine Vet Educ 23 (2), 101-104. 
  • Textor J (2011) Autologous biological treatment for equine musculoskeletal injuries: platelet-rich plasma and IL-1 receptor antagonist protein. Vet Clin Equine 27 (2), 275-298 PubMed.
  • DeRossi R et al (2009) Effects of platelet-rich plasma gel on skin healing in surgical wound in horses. Acta Cir Bras 24 (4), 276-281 PubMed.
  • Fortier L A & Smith R K W (2008) Regenerative medicine for tendinous and ligamentous injuries of sport horses. Vet Clin North Am Equine Pract 24, 191-201 PubMed.
  • 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. JAVMA 232 (10), 1515-1520 PubMed

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