Joost Peerbooms

140 Chapter 9 In this thesis, the use of platelet-rich plasma (PRP) in the treatment of somemusculoskeletal disorders is evaluated. Several studies are described to improve knowledge about the basic principles of PRP and to demonstrate its advantages and disadvantages in various applications. Chapter 1 is a general introduction to the use of PRP in musculoskeletal disorders, with a focus on its use in tendinopathy and wound healing. A brief discussion of the history of PRP is provided. In addition, techniques for preparing PRP and releasing growth factors from the platelets are examined; this is followed by a discussion of the effectiveness of PRP. The last section of this chapter gives an overview of the thesis. Chapter 2 is a review of the literature on commercial PRP separation systems and the resulting concentrations of blood components. There is a large heterogeneity among PRP separation systems regarding the concentrations of platelets, leukocytes, and growth factors in the resulting PRP. The type of PRP to be used in treatment should be chosen based on the specific clinical field of application. As the ideal concentrations of blood components and growth factors for any given application are yet to be established, future research should focus on determining the type of PRP most suitable for each specific field. Chapter 3 describes a randomised clinical trial in patients undergoing total knee arthroplasty (TKA). We investigated whether the use of PRP in TKA would improve wound healing and knee function while reducing blood loss and the need for analgesics. A total of 102 patients undergoing TKA were randomly assigned to a PRP- group ( n = 50) or to a control-group (C) ( n = 52). The primary analysis included 73 participants (PRP = 32 and C = 41) and compared postoperative wound scores, VAS scores, WOMAC scores, knee function, use of analgesics, and pre- and post-operative levels of haemoglobin between the two groups. Twenty-nine participants were lost to follow-up. The characteristics of the protocol-compliant patients were similar to those of the excluded patients. Analysis was per protocol and focused on the remaining 73 patients. At baseline and after 3 months of follow-up, there were no statistically significant differences between the PRP group and the control group regarding age, height, weight, sex, side of operation, platelet count, haemoglobin values, severity of complaints, and level of pain. In patients undergoing TKA, the application of PRP to the wound site did not promote wound healing. Moreover, we also found that the use of PRP had no effect on pain, knee function, or haemoglobin values. Chapter 4 reviews the use of PRP in upper extremity disorders. PRP has been used since 1990 in the dental and facial reconstructive surgery. The application in other areas has been increased rapidly as a result of the reported positive effects on bone, muscle and tendon regeneration as well as wound healing. In vitro studies show that growth factors released by platelets have a positive effect on the repair of soft tissue.