PRP or not PRP? That is the question.

Since the introduction of platelet concentrates as a topical adjuvant therapy to treat chronic leg ulcers in the late 1980, the use of platelet products has been extended to many fields of medicine, with the aim of promoting the healing process of various pathologies in numerous kinds of tissues. Platelet-rich plasma (PRP) and other blood derivates, used alone or in combination with biomaterials, are under investigation in innumerable preclinical studies or even already used in clinical practice. Fields of application include dermatology, ophthalmology, dentistry, cosmetic, plastic and maxillofacial surgery, neurosurgery, urology, cardiothoracic surgery, as well as orthopedics, sport medicine, and recently, breakthroughs have been claimed even for the treatment of baldness. Looking more specifically into the orthopedic field, applications of PRP are numerous and heterogeneous: it has been used as adjuvant to promote the healing of bone defects and nonunions, bone fractures, laminectomy, spinal fusion, joint arthroplasty, bone implant osseointegration, and the treatment of various traumatic or degenerative pathologies of tendons, ligaments, muscle, and cartilage. The rationale for using platelets in so many fields for the treatment of different tissues is that platelets constitute a reservoir of critical growth factors (GFs) and bioactive molecules that govern and regulate the healing process, which is quite similar in most tissues. Moreover, the attractive possibility of using patients’ own growth factors, concentrated and in physiologic proportions, to enhance reparative processes in tissues with low healing potential, promising preliminary clinical findings, and their safety might explain the wide use of this biological approach. However, although the popularity of PRP has reached a peak and there is lot of enthusiasm, talking, and advertising, it is realistic to say that nothing works for everything.