Platelet-Rich Plasma: Regenerative Medicine: Sports Medicine, Orthopedic, and Recovery of Musculoskeletal Injuries

368 Pages·2014·5.54 MB·English

by  José F. Lana

Lecture Notes in Bioengineering
José Fábio Santos Duarte Lana
Maria Helena Andrade Santana
William Dias Belangero
Angela Cristina Malheiros Luzo Editors
Platelet-Rich
Plasma
Regenerative Medicine: Sports
Medicine, Orthopedic, and Recovery
of Musculoskeletal Injuries
Lecture Notes in Bioengineering
For furthervolumes:
http://www.springer.com/series/11564
José Fábio Santos Duarte Lana
Maria Helena Andrade Santana
William Dias Belangero
•
Angela Cristina Malheiros Luzo
Editors
Platelet-Rich Plasma
Regenerative Medicine: Sports
Medicine, Orthopedic, and Recovery
of Musculoskeletal Injuries
123
Editors
JoséFábio SantosDuarte Lana William DiasBelangero
Research Instituteof SportsMedicine Department of Orthopaedicand
Orthopedics and Regeneration—iMOR Traumatology, Facultyof Medical
Uberaba, MG Sciences
Brazil Universityof Campinas
Campinas,SP
and Brazil
Member oftheRegenerative Angela Cristina Malheiros Luzo
and Cell TherapyGroup, Hemocentro Haematology andHemotherapy Center
Universityof Campinas,Unicamp Umbilical CordBloodBank
Campinas,SP Universityof Campinas
Brazil Campinas,SP
Brazil
Maria HelenaAndrade Santana
Department of Materials and Bioprocesses
Engineering, School ofChemical
Engineering
Universityof Campinas
Campinas,SP
Brazil
ISSN 2195-271X ISSN 2195-2728 (electronic)
ISBN 978-3-642-40116-9 ISBN 978-3-642-40117-6 (eBook)
DOI 10.1007/978-3-642-40117-6
SpringerHeidelbergNewYorkDordrechtLondon
LibraryofCongressControlNumber:2013950744
(cid:2)Springer-VerlagBerlinHeidelberg2014
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Foreword I
Whentheeditorsofthisbookinvitedmetowritetheselines,IaskedmyselfwhatI
couldoffertoarouseorincreasethereader’sinterest.Ithoughtacomparisonwith
thehistoryoftheinitiationofothertreatmentsascontroversialasthisonecouldbe
the key.
Orthopaedic Surgery underwent a big change when fractures that had previ-
ously been treated conservatively started being treated surgically. The aim was to
ensure two things: first get a better fracture reduction, and secondly, to ensure
better cohesion-congruency of the fragments and by so doing allow for earlier
mobility.
There were those that argued for and against this approach but over time the
advantages that fracture osteosynthesis brings became highlighted.
Years later a similar event occurred when endoscopic surgery was developing
intherespiratory,digestive,andrenalsystems;itreachedthejointsandinthefirst
thirdofthetwentiethcenturyitbecamepossibletovisualizetheinsideoftheknee.
Thusbeganarticularendoscopicsurgerywithmanydifferencesofopinionandwas
onlysupportedbyafew,whilemanyothersdidnotbelieveinthebenefitsitcould
bring.Acceptanceofthissurgicaltreatmenttookmanyyearsandonlybegantobe
taken advantage of in the 1950s.
However, over time and after many studies the aforementioned surgical tech-
niquehasbecomeroutineforintraarticularsurgery.Theacquisitionofknowledge
by orthopedic surgeons, the design of new instruments and more accurate diag-
nosis of intra-articular pathologies have allowed this surgical technique to offer
more solutions and therefore become more and more popular.
Now it is biological therapies that are under the spotlight in the scientific
community. Evidence-based medicine, good for the level of excellence that it
demands, making it necessary to perform a lot of research to substantiate the
effectiveness of treatments mentioned can be broadly divided into three groups:
• those using the implantation of a biological inducer (Scaffold);
• those that use substances that create favorable environments for the develop-
ment of cells (Growth Factors);
• and those that implant cells in one step or two, with the difference between the
twobeingthecultureofcells(twostepswithagreaternumberofcells)or(one
step with a lower number).
v
vi ForewordI
IhopethisshorttourthroughthehistoryofOrthopaedicSurgeryandthisbrief
summary of biological therapies serve to encourage the reader to delve into the
exciting world of tissue regeneration.
Iwouldliketogivemymostsincerecongratulationstotheeditorsforthework
they have done.
Barcelona, April 2013 Ramon Cugat
Foreword II
PlateletRichPlasma(PRP)isnowgaininginternationalrecognitionasatreatment
modality. PRP came into existence during the 1980s and has since been used in
many areas of medicine.
My exposure to PRP and Regenerative Medicine began during my Sports
Medicine Fellowship at South Pointe Cleveland Clinic, with Dr. Zenos Vangelos.
The Orthobiologic premise of helping to facilitate healing of tissue had tremen-
dous appeal to me. Having also experienced PRP treatments, I can speak of the
effectivetreatmentoutcome,whichIhavenowseenreplicatedinthousandsofmy
patients.
Todate,therehavebeenthousandsofresearchstudiespublishedonthetopicof
PRP, yet as with many relatively new treatments, there are often many more
questions than answers. This challenge has galvanized our authors to provide the
first complete textbook on Platelet Rich Plasma. This comprehensive textbook
lists the most current thoughts on PRP basic science, surgical applications, and
non-surgical applications. In doing so, it is our hope that this textbook will help
provideanswerstosomeofthesedifficultquestionsandserveasaspringboardfor
further research in this treatment modality.
IwouldliketothankDr.StevenSampsonforhiskindinvitationtobeapartof
thisendeavorandDr.JoséFábioSantosDuarteLanaforcompilinganoutstanding
group of internationally renowned authors in this groundbreaking textbook on
Platelet Rich Plasma.
Special thanks to my wife Yael, for being very understanding, supportive, and
loving.
Adam Weglein
vii
Foreword III
Regenerative Medicine holds tremendous promise and is quickly gaining popu-
larity worldwide. With today’s global communication, leading physicians are
creating a community to foster development of innovative therapies. Although
publishingliteratureasaclinicianistediousandchallenging,itiscriticaltoshare
ourexperienceswithoneanothertoadvanceourunderstandingof‘‘orthobiologic’’
treatments. Dr. José Fábio Santos Duarte Lana, a world renowned orthopedist,
should be commended for assembling such an international collaborative effort
with physicians and researchers.
Currentlytherearefew,ifany,medicaltextbooksthatattempttocoverthespan
of regenerative medicine techniques in orthopedic medicine. As clinicians in our
respectiveofficeswepracticetheartofmedicinedaily.Oftentimeswhenitcomes
to regenerative medicine we must become ‘‘pioneers’’ deciding on protocols that
have not been laid out before us. For example, when I first began using PRP
(Platelet Rich Plasma) for knee osteoarthritis there was no evidence-based medi-
cineorguidelinestofollow.Iwasdriventohelppatientsthathavefailedallofthe
current treatment options and the science theoretically made sense. Several years
later this textbook may serve as a reference for new doctors or ‘‘pioneers’’ to
followandtostimulatecreativityandfurtherevolutionofthismostexcitingfield.
After using PRP to treat thousands of patients with complex conditions, we
continue to modify our protocols and ask more questions. Every month new
researchisemerging, adding toour understanding ofthis novel therapy. This text
addresses the growing need for standardization of technique and platelet prepa-
rationwhenassessingitsvalidityforclinicaloutcomes.Whilesciencehasallowed
us to greatly understand that platelets may amplify tenocytes or chondrocytes in
vitro, we are now just collecting robust data in the clinical realm.
Most physicians implementing biologic medicine share a common enthusiasm
and passion for our work. This book brings together our collective efforts to
challenge the medical community to decide if and how they will integrate these
principles into their medical practice.
This comprehensive textbook covers numerous critical topics including PRP
basic science, literature review, treatment of tendon, ligament, muscle, meniscus,
cartilage, bone and wound healing, and surgical applications.
PRPisthefirsttruebiologictherapythathashitorthopedicsbystorm.Itsease
of use and generally high safety profile has allowed it to propel itself into the
ix
x ForewordIII
mainstream of physicians and their patients worldwide. Through the early
administration of PRP in professional athletes, this sensationalized therapy is
graduallysustainingitselfwithgeneraluseineverydaypatientsseekingalternative
conservative options. Textbooks like this are critical to provide a framework for
which future biologically based treatments may emerge and proliferate.
Steve Sampson
Preface
IfirstcameacrossPlateletRichPlasma(PRP)whileattendingtheWorldCongress
ofArthroscopyandSportsMedicineinBuenosAyres,Argentina2006.Dr.Ramon
Cugat, from Spain, gave a fascinating PRP lecture at this meeting titled ‘‘Los
Factores de Crescimiento in la Medicina Deportiva.’’ I was delighted with the
possibility of stimulating healing through the use of an anabolic-autologous
environment with minimal risk to the patient.
I subsequently visited Dr. Cugat in Barcelona and became trained in Platelet
Rich in Growth Factors (PRGF).
I returned to Brazil with a strong interest in Regenerative Medicine and PRP.
This newfound interest galvanized me to find a university with a strong focused
regenerative research division. The University of Campinas (UNICAMP) has an
outstanding,world-renownedreputationasleadersinmedicalinnovation.Theidea
ofresearchingPRPwasenthusiasticallyreceivedbyagroupofprofessorswhoset
upaprojectinvolvingbasicandappliedsciences.UNICAMPhasnowdevelopeda
PRP research center in large part due to the hard work of professors William D.
Belangero, Angela C. M. Luzo, Joyce M. A. Bizzacchi, and Maria Helena A.
Santana.
Platelet Rich Plasma is a rapidly growing and developing treatment modality,
with new research coming out weekly. The aim of this text will be to provide a
concisereviewofthecurrentliteratureandpracticalaspectsofPRP.Wehopethat
this text will serve as a guide to both clinicians and researchers. Platelet Rich
Plasma is emerging as a primary source of autologous products in Regenerative
Medicine. A true precursor and promoter of the healing process along with the
Scaffolds and Stem Cells. This new technology opens up a broad spectrum of
action andsimultaneously increasesthechallengestobescientifically confronted.
Standardizedproductsorautologousbiomaterialoftenseemimpossible.Unlike
synthetic biomaterial that comes from the industry with a controlled quality, an
autologous biomaterial depends on the health of the individuals. Therefore, it is
impossibletosetanexact qualitywhenitinvolvesaplethora ofvariables ofeach
individual’sgeneralhealth.Severalstudiesthathavecollecteddatahaddifficulties
to compare and standardize the technique. However, scientific knowledge of the
phenomena, variables, and interactions involved in the formulation of PRP have
allowed us to modulate its behavior and form the basis of its standardization for
clinicalapplications.Moreover,itisalsopossibletohavePRPtailoredforspecific
xi