From the Guidelines
For most musculoskeletal applications, leukocyte-poor PRP (LP-PRP) is generally preferred over leukocyte-rich PRP (LR-PRP) due to its anti-inflammatory properties and ability to provide growth factors for tissue healing while minimizing inflammatory effects. The main difference between LR-PRP and LP-PRP lies in their leukocyte content, with LR-PRP containing 5-8 times the baseline concentration of leukocytes and LP-PRP containing less than the baseline concentration 1. The preparation method plays a crucial role in determining the leukocyte content, with single-spin techniques typically producing LP-PRP and double-spin techniques often yielding LR-PRP.
Some key considerations when choosing between LR-PRP and LP-PRP include:
- The treatment target: LP-PRP is favored for osteoarthritis, tendinopathies, and cartilage injuries due to its anti-inflammatory properties, while LR-PRP may be beneficial for acute muscle injuries or situations requiring antimicrobial effects due to its pro-inflammatory properties 1.
- The concentration of platelets: ideally, the concentration of platelets in both formulations should be 2-5 times baseline levels to optimize therapeutic effects.
- Treatment protocols: typically involve 1-3 injections spaced 2-4 weeks apart, with results potentially lasting 6-12 months depending on the condition being treated.
It's essential to note that the classification system for PRP includes the activation method, total volume used, frequency of dosing, subcategories of activation, platelet concentration, and preparation techniques, as outlined in Table 1 of the study by 1. This classification system can help guide the choice between LR-PRP and LP-PRP, as well as other types of PRP preparations, such as red blood cell-rich PRP (Red-PRP) and platelet-rich fibrin (PRF). Ultimately, the choice between LR-PRP and LP-PRP should be based on the individual patient's needs and the specific condition being treated, taking into account the potential benefits and risks of each formulation.
From the Research
Leukocyte Rich vs Leukocyte Poor PRP
- The provided studies do not directly compare leukocyte rich vs leukocyte poor PRP, but they discuss the use of platelet-rich plasma (PRP) in treating musculoskeletal injuries and diseases associated with orthopedic injuries 2, 3, 4, 5, 6.
- PRP is derived from centrifuging whole blood and has a platelet concentration higher than that of whole blood, containing numerous growth factors that can facilitate healing and earlier return to sport after musculoskeletal injury 2.
- The use of PRP in orthopedic sports medicine has become more prevalent, with current literature exhibiting that PRP injections are relatively safe and can potentially accelerate or augment the soft tissue healing process 4.
- A systematic review of the molecular and biologic effects of PRP in ligament and tendon healing and regeneration found that PRP added in culture media was highly associated with increased cell proliferation, migration, viability, and total collagen production of both ligament- and tendon-derived cells 5.
- However, the optimal preparation and application of PRP, including the role of leukocytes, are still being researched and debated, with some studies demonstrating variable or even negative effects of PRP on tendon and ligament regeneration 5.