Plasma Rich in Growth Factors (PRGF)
Plasma rich in growth factors is a biological delivery system of a complex mixture of bioactive proteins essential to natural repair, including anabolic and protective factors for cartilage, and other important growth factors. In the past decade, several crucial roles of growth factors have been identified in joint repair.
Growth factors (GFs) released from activated platelets initiate and modulate wound healing in both soft and hard tissue. The autologous nature of PRGF gives it a significant advantage in tissue engineering applications which can be improved with the addition of adjuncts that increase the proliferation and differentiation of progenitor or stem cells.
The efficacy of this treatment resides in the continuous, local release of a wide range of GFs and proteins necessary for healing in a process that imitates physiological tissue repair
Safety is provided by the anti-bactericidal secretion of proteins by platelets which participate directly in the elimination of bacteria during sepsis. Platelets ability to reduce pain is due to a suppression of the inflammatory phase and a relatively low level of interleukins.
Platelet-rich plasma (PRP) is being increasingly used to promote musculoskeletal healing by the stimulation of angiogenesis, chemotaxis, and cell proliferation. PRP has been shown to promote recovery in cases of tendinous and ligamentous injury and muscular strain and has been used to shorten recovery and return to play (RTP) duration. PRP products are prepared from autogenous blood and administered by injection into the site of injury or through direct gel application during surgery. Preparation rich in growth factors (PRGF) is a form of PRP, shown to promote the healing of soft tissue injuries, cartilage and bony defects.
Treatment of Ankle Sprains:
The effect of ultrasound-guided PRP therapeutic injections on recovery, RTP, and dynamic stability following a grade 3 injury of the anterior-inferior tibiofibular ligament (AITFL) of the ankle was studied in a group of elite athletes.
The athletes were able to return to play significantly sooner and also have significantly less pain. Sonographic findings suggested that injured AITFL demonstrated improved healing. This confirms that treatment with PRP can expedite the RTP of athletes with complete AITFL injuries.
Basic science research and preliminary clinical data support the use of PRP-derived growth factors to improve cartilage healing and in the management of soft tissue injuries. Platelets within the zone of injury are responsible for the release of biologically active factors, and PRP therapies are designed to enhance this process by delivering supra-physiologic concentrations. PRP also provides a better environment, promotes more tissue organization and prevents of excessive scar tissue formation.
Athletes suffering from high ankle sprain can benefit from PRP ultrasound-guided injections and should expect a shorter RTP time/time lost from sport and a rapid stabilization of the syndesmosis joint, with diminished long-term residual pain.
Treatment of partial ACL tears of the Knee:
The application of PRGF in the ACL, has been the focus of several studies, which have not only shown structurally improved tissues but also enhanced ACL graft healing or even in the autologous central third patellar tendon harvest site.
The role of PRGF has been linked to the regeneration processes in tendon and ligament tissue with early return to competition level sport and early maturation of ligaments and tendons as well as a reduction in pain. It is important to point out that findings from both clinical studies and tissue studies coincide on the importance of the role of platelet-rich plasma in the early phase of repair.
The fact that patients with partial ACL tears receiving PRGF treatments are able to return to play at pre-injury level gives a clear indication of the degree of improvement in these patients from a clinical point of view.
Treatment of Osteochondral Lesions of the Talus bone in the Ankle:
Platelet-rich plasma (PRP) has been proposed as a novel treatment modality for the management of articular cartilage injuries of the ankle and other joints, with reduced pain and improved function after intra-articular injection.
Intra-articular administration of PRGF could retard or prevent progression of degeneration of the joint’s cartilage. Platelet-rich plasma also improves the quality of synovial fluid by inducing the endogenous secretion of hyaluronic acid (HA) by synovial cells. As a result, PRP exerts an anti-inflammatory action, augmenting the flow of synovial fluid and normalizing its synthesis, inhibiting the degradation of endogenous HA, and relieving joint pain.
Nonoperative treatment with PRGF is comparable in efficacy, in the short term, to the reported results after surgical intervention and should be considered as a valid first-line treatment for osteochondral lesions.
Therapeutic intra-articular injections of PRGF should be considered as a first-line treatment option. The treatment is safe and provides relief that lasts at least 6 months.
Treatment of Osteoarthritis:
PRGF have the capacity to stimulate chondrocytes to regenerate cartilage, which undergoes degeneration in patients with osteoarthritis.
Intra-articular infiltration of autologous PRGF in patients with OA has local, effective and temporal effects reducing pain and restoring function, without provoking local or systemic adverse events. PRGF may be particularly useful in elderly OA patients who may not tolerate NSAIDs and in patients in whom this treatment is contraindicated. The simplicity of autologous PRGF use makes it an attractive option for clinicians and OA patients.
Treatment of Bone fractures:
Several platelet growth factors are released during fracture repair, and these can trigger the activation of proliferation and movement of mesenchymal cells, osteoblasts, and chondrocytes to the fracture site. Studies in surgery patients have shown their efficacy in achieving more rapid bone consolidation.
Plasma rich in growth factors (PRGF) has been used in delayed healing and in non-union of fractures. In some cases of delayed union fractures, biological treatment may be recommended before considering surgery.
Three percutaneous injections of PRGF (one every 2 weeks) delivered into the delayed union site may be enough to heal the fracture. The patient may regain complete mobility of the shoulder without pain and be able to carry out all the normal life activities.