The Positive Effects of
Different Platelet-Rich Plasma Methods on Human Muscle, Bone, and Tendon Cells

Mazzocca AD, McCarthy
MB, Chowaniec DM, Dugdale EM, Hansen
D, Cote MP, Bradley JP, Romeo
AA, Arciero RA, Beitzel K.  Am J Sports Med. 2012 Aug;40(8):1742-9. Epub 2012 Jul 16.

of the most widely disputed hot topics in sports medicine today is the
utilization of PRP.  While the theory of
how PRP works is solid, there has been a lag in the literature to back it
up.  At SMR we have covered recent
research showing that PRP does and doesn’t work.  However, one item that hasn’t been covered in
general is the PRP preparation.  While
multiple preparation techniques are available commercially, there has not been
any independent analysis to delineate which preparation might be better suited
in different situations.  Therefore, the
investigators compared 3 different PRP preparation techniques and the effect on
cell proliferation in bone, muscle and tendon tissue harvested post shoulder
arthroplasty, latissimus dorsi transfer and biceps tenodesis,
respectively.  Blood samples were
collected from 8 patients, prepared and administered to the tissue types. The 3
preparation techniques were 1) a low platelet concentration technique (PRPLP)
achieved through a 5-minute, single-spin at 1500 RPM utilizing the Arthrex
double-syringe format. This technique elicited 3mL of PRPLP containing the
lowest concentration of platelets (LP). 2) A double spun (PRPDS) preparation
was obtained using a previous method as described by de Mos et al. The blood
sample was spun for 5 minutes at 1500 RPM then the plasma was drawn up and
centrifuged for 20 minutes at 6300 RPM, which separated the plasma/platelets
further. 3) A high platelet concentration sample (PRPHP) was obtained through
spinning a 27mL blood sample for 15 minutes at 3200 RPM. This separated the
sample into 3 distinct layers.  The
middle layer containing platelets and WBC’s was drawn up and utilized for this
study.  The tissue samples were prepped
and isolated through various techniques dependent on the tissue type. Once
isolated, 2500cm2 of the tissue samples were placed in petri dishes
and exposed to the 3 different PRP samples and monitored microscopically for 96
hours and compared to multiple control samples. 
After 96 hours, radioactive thymidine was utilized to measure cell proliferation in each sample.
Multiple growth factors were also measured for all control and experimental
conditions at this time frame.  Of the 3
PRP preparation techniques, results indicate that the PRPHP technique elicited
the highest concentration of platelets, WBC and growth factors. However, higher
concentrations did not necessarily equate to increased cell proliferation in
all tissue types.  PRPLP and PRPDS both
showed significant increase in osteoblast proliferation when compared to
controls.  PRPLP and PRPDS also showed
significantly higher levels of myocyte proliferation when compared to control
and PRPHP preparations.  Tenocytes
exhibited significant proliferation for all PRP conditions when compared to
controls, but no significant difference existed when compared to the other

study is interesting for a few reasons, due to the fact that we still do not truly
understand how PRP works or where its sports medicine utility lies. The results
from this study state the case that preparation might be an integral component
to the success/failure of the intervention. 
One item that must be examined is the concentration of growth factors in
all preparations. The PRPHP technique elicited the greatest quantity of each
growth factor examined across all tissue types, but not the highest levels of
cell proliferation. That begs the questions: 1) Are the growth factors as
integral to PRP’s success as we previously believed, or is there an optimal
range?  2) Does PRP have different
effects predicated for different tissue types? 
The authors do state that this study isn’t without limitations, most
notably that an in-vitro setting might not accurately reflect PRP’s in-vivo
properties.  What are your thoughts on
this study? What PRP techniques do you and your physicians utilize? Would you
consider different preparations based upon what type of tissue is injured?

by:  Mark Rice
by:  Stephen Thomas


Mazzocca AD, McCarthy MB, Chowaniec DM, Dugdale EM, Hansen D, Cote MP, Bradley JP, Romeo AA, Arciero RA, & Beitzel K (2012). The positive effects of different platelet-rich plasma methods on human muscle, bone, and tendon cells. The American Journal of Sports Medicine, 40 (8), 1742-9 PMID: 22802273