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Am J Sports Med. 2015 Dec;43(12):2898-906. doi: 10.1177/0363546515608157. Epub 2015 Oct 12.

Leukocyte-Reduced Platelet-Rich Plasma Normalizes Matrix Metabolism in Torn Human Rotator Cuff Tendons.

Author information

1
Department of Clinical Sciences, Cornell University, Ithaca, New York, USA.
2
Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, USA cole.research@rushortho.com.
3
Department of Orthopedics, Rush University Medical Center, Chicago, Illinois, USA.
4
Department of Population Medicine and Diagnostic Sciences, Cornell University, Ithaca, New York, USA.

Abstract

BACKGROUND:

The optimal platelet-rich plasma (PRP) for treatment of supraspinatus tendinopathy has not been determined.

PURPOSE:

To evaluate the effect of low- versus high-leukocyte concentrated PRP products on catabolic and anabolic mediators of matrix metabolism in diseased rotator cuff tendons.

STUDY DESIGN:

Controlled laboratory study.

METHODS:

Diseased supraspinatus tendons were treated with PRP made by use of 2 commercial systems: Arthrex Autologous Conditioned Plasma Double Syringe System (L(lo) PRP) and Biomet GPS III Mini Platelet Concentrate System (L(hi) PRP). Tendon explants were placed in 6-well plates and cultured in L(lo) PRP, L(hi) PRP, or control media (Dulbecco's Modified Eagle Medium + 10% fetal bovine serum) for 96 hours. Tendons were processed for hematoxylin-eosin histologic results and were scored with the modified Bonar scale. Group 1 tendons were defined as moderate tendinopathy (Bonar score <3); group 2 tendons were assessed as severely affected (Bonar score = 3). Transforming growth factor β-1 (TGFβ-1), interleukin-1β (IL-1β), interleukin-1 receptor antagonist (IL-1Ra), interleukin-6 (IL-6), interleukin-8 (IL-8), and matrix metalloproteinase-9 (MMP-9) concentrations in PRP media were measured by use of enzyme-linked immunosorbent assay after 96 hours of culture with diseased tendon. Tendon messenger RNA expression of collagen type I (COL1A1), collagen type III (COL3A1), cartilage oligomeric matrix protein (COMP), MMP-9, MMP-13, and IL-1β was measured with real-time quantitative polymerase chain reaction.

RESULTS:

Leukocytes and platelets were significantly more concentrated in L(hi) PRP compared with L(lo) PRP. Increased IL-1β was present in L(hi) PRP after culture with group 1 tendons. IL-6 was increased in L(hi) PRP after culture with group 2 tendons. Both TGFβ-1 and MMP-9 were increased in L(hi) PRP after culture with either tendon group. In L(lo) PRP cultures, IL-1Ra:IL-1β in PRP used as media and COL1A1:COL3A1 gene expression were increased for group 1 tendon cultures. Gene expression of MMP-9 and IL-1β was increased in group 2 tendons cultured in L(lo) PRP. There was no significant difference in the expression of MMP-13 or COMP in either group of tendons cultured in L(lo) PRP or L(hi) PRP.

CONCLUSION:

L(lo) PRP promotes normal collagen matrix synthesis and decreases cytokines associated with matrix degradation and inflammation to a greater extent than does L(hi) PRP in moderately degenerative tendons. In severely degenerative tendons, neither PRP preparation enhanced matrix synthesis.

CLINICAL RELEVANCE:

L(lo) PRP may promote healing in moderately degenerative rotator cuff tendons.

KEYWORDS:

biological healing enhancement; growth factors; platelet-rich plasma; rotator cuff; shoulder

PMID:
26460099
DOI:
10.1177/0363546515608157
[Indexed for MEDLINE]

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