What are the medical uses for Platelet-rich plasma (PRP)?

Medical Uses for Platelet-Rich Plasma (PRP)

PRP is definitively appropriate for general wound healing, while its use remains uncertain for most other clinical applications including tendon injuries, acute muscle injuries, bone healing, osteoarthritis, and cosmetic purposes. 1

Established Clinical Applications

Wound Healing (Primary Indication)

• General wound healing is the only application with consensus support from expert guidelines (median expert score of 7 out of 9). 1
• PRP promotes tissue repair through release of growth factors and cytokines from platelet α-granules that stimulate angiogenesis, cell migration, proliferation, and differentiation. 2
• The activated platelets create a fibrin scaffold that serves as a temporary three-dimensional matrix supporting cellular regeneration and tissue remodeling. 2

Dental and Oral Surgery

• PRP enhances bone regeneration and wound healing after dental procedures, particularly in poorly vascularized areas. 3
• Specific applications include tooth extractions (improving soft tissue healing and bone regeneration), periodontal surgery (best results when combined with other materials), and implant surgery (effective as coating material). 4
• Shows promise in managing bisphosphonate-related osteonecrosis of the jaw when combined with necrotic bone curettage. 4

Dermatologic Applications

• Used for hair loss (alopecia), skin rejuvenation, acne scars, diabetic ulcers, venous leg ulcers, and pigmentation disorders (melasma, vitiligo). 5
• The anti-inflammatory and growth factors initiate a healing cascade promoting tissue growth and regeneration. 5

Applications with Uncertain Evidence

The 2018 International Society on Thrombosis and Haemostasis expert panel rated the following as uncertain (median scores of 4-6.5 out of 9): 1

• Burn injuries (median score 6.5)
• Tendon injuries (median score 5.5)
• Acute muscle injuries (median score 5)
• Bone healing (median score 6)
• Maxillofacial injuries (median score 5.5)
• Sports injuries (median score 5.5)
• Osteoarthritis (median score 6.5)
• Skin aging/beauty therapy (median score 4 - lowest rating)

Orthopedic and Sports Medicine

• Despite widespread use for cartilage repair, bone healing, and tissue regeneration, the American Academy of Orthopaedic Surgeons only "acknowledges potential benefits" without definitive endorsement. 3
• PRP contains growth factors that theoretically reduce inflammation and improve tissue anabolism, but clinical evidence remains inconsistent. 6

Plastic Surgery

• The American Society of Plastic Surgeons notes PRP can enhance graft survival and promote angiogenesis in poorly vascularized tissues, but this represents acknowledgment rather than strong recommendation. 3

Critical Limitations Affecting All Applications

Standardization Problems

• The field suffers from severe lack of standardization in preparation methods, terminology, purity, content, and quality control. 1, 2
• Different preparation techniques (g-force, centrifugation time, activation methods) result in significant variations in platelet yields, concentration, purity, viability, and activation status. 1, 2
• Commercial PRP devices produce widely varying products, making it impossible to compare clinical trial results or establish consistent efficacy. 1

Evidence Quality Issues

• Many clinical trials have been conducted without clear definition or quantification of PRP biological properties, leading to varying efficacies and outcomes. 1
• Large randomized controlled trials are lacking for most applications. 7
• The International Society on Thrombosis and Haemostasis emphasizes that further mechanistic studies are needed to elucidate the optimal combination of bioactive factors. 2

Safety Profile

• PRP is considered cost-effective, minimally invasive, and safe due to its autologous nature (minimal immunogenicity risk). 1, 6
• Few complications are reported, making it an attractive option when evidence supports its use. 6

Clinical Decision Algorithm

For general wound healing: Use PRP as it has consensus expert support. 1

For dental/oral surgery: Consider PRP as adjunctive therapy, particularly for tooth extractions, periodontal procedures, and implant surgery. 3, 4

For orthopedic/sports injuries, osteoarthritis, or cosmetic applications: Inform patients that evidence is uncertain and inconsistent, and that standardization problems make outcome prediction difficult. 1 Consider PRP only after conventional treatments have been optimized, given its safety profile and patient preference for conservative management. 6

For all applications: Ensure proper preparation methodology is documented, including anticoagulant type, centrifugation parameters, platelet concentration, purity, activation status, and activation procedure if used. 1