
{"id":21402,"date":"2021-01-15T09:00:48","date_gmt":"2021-01-15T09:00:48","guid":{"rendered":"https:\/\/www.btitrainingcenter.com\/platelet-rich-plasma-applications-for-achilles-tendon-repair-a-bridge-between-biology-and-surgery\/"},"modified":"2025-04-09T16:16:23","modified_gmt":"2025-04-09T15:16:23","slug":"platelet-rich-plasma-applications-for-achilles-tendon-repair-a-bridge-between-biology-and-surgery","status":"publish","type":"post","link":"https:\/\/www.btitrainingcenter.com\/pt-pt\/platelet-rich-plasma-applications-for-achilles-tendon-repair-a-bridge-between-biology-and-surgery\/","title":{"rendered":"Platelet-Rich Plasma Applications for Achilles Tendon Repair: A Bridge between Biology and Surgery"},"content":{"rendered":"<div class=\"wpb-content-wrapper\"><p>[vc_row content_text_aligment=&#8221;left&#8221; row_background_lines=&#8221;no&#8221;][vc_column][vc_column_text]<\/p>\n<h3 class=\"title\">Abstract<\/h3>\n<div id=\"enc-abstract\" class=\"abstract-content selected\">\n<div id=\"enc-abstract\" class=\"abstract-content selected\">\n<div id=\"enc-abstract\" class=\"abstract-content selected\">\n<p>Achilles tendon ruptures are very common tendon ruptures and their incidence is increasing in modern society, resulting in work incapacity and months off sport, which generate a need for accelerated and successful therapeutic repair strategy. Platelet-rich plasma (PRP) is emerging as adjuvant human blood-derived constructs to assist Achilles tendon rupture treatment. However, myriad PRP preparation methods in conjunction with poor standardization in the modalities of their applications impinge on the consistent effectiveness of clinical and structural outcomes regarding their therapeutic efficacy. The purpose of this review is to provide some light on the application of PRP for Achilles tendon ruptures. PRP has many characteristics that make it an attractive treatment. Elements such as the inclusion of leukocytes and erythrocytes within PRP, the absence of activation and activation ex vivo or in vivo, the modality of application, and the adjustment of PRP pH can influence the biology of the applied product and result in misleading therapeutic conclusions. The weakest points in demonstrating their consistent effectiveness are primarily the result of myriad PRP preparation methods and the poor standardization of modalities for their application. Selecting the right biological scaffold and applying it correctly to restitutio ad integrum of ruptured Achilles tendons remains a daunting and complex task.<\/p>\n<\/div>\n<p><strong class=\"sub-title\">Keywords:\u00a0<\/strong>Achilles; PRGF; platelet-rich plasma; tendon.<\/p>\n<\/div>\n<\/div>\n<p>[\/vc_column_text][vc_empty_space][vc_column_text]<\/p>\n<h3>Figures<\/h3>\n<p>[\/vc_column_text][vc_empty_space][\/vc_column][\/vc_row][vc_row content_placement=&#8221;middle&#8221; content_text_aligment=&#8221;center&#8221;][vc_column]<div class=\"qodef-image-gallery qodef-grid-list qodef-disable-bottom-space  qodef-ig-grid-type qodef-four-columns qodef-tiny-space  qodef-image-behavior-lightbox\">\n\t<div class=\"qodef-ig-inner qodef-outer-space\">\n\t\t\t\t\t<div class=\"qodef-ig-image qodef-item-space\">\n\t\t\t\t<div class=\"qodef-ig-image-inner\">\n\t\t\t\t\t\t\t\t\t\t\t<a itemprop=\"image\" class=\"qodef-ig-lightbox\" href=\"https:\/\/www.btitrainingcenter.com\/wp-content\/uploads\/2021\/08\/ijms-22-00824-g001.jpg\" data-rel=\"prettyPhoto[image_gallery_pretty_photo-199]\" title=\"&lt;strong&gt;Figure 01&lt;\/strong&gt; An autologous liquid-to-gel dynamic scaffold as a carrier of biological mediators in tissue repair. When liquid plasma rich in growth factors (GFs) is applied directly into tissue, the newly formed three-dimensional matrix clot traps many of the released growth factors and cytokines from platelet degranulation and from plasma by binding them to the heparin sulfate proteoglycan domains of fibrin matrix components in a non-diffusible mode (yuxtacrine or matricrine) (A). However, some GFs in a diffusion mode (autocrine and paracrine) will directly reach their cognate cell-surface receptor (D), thereby inducing an immediate cell-biosynthetic and cell-behavior modification (C). The ensuing progressive biodegradation of a fibrin clot is mediated by the serine protease plasmin, which is yielded through both the activation of plasminogen by a tissue plasminogen activator [24] and the immune and mesenchymal cells that migrate into the clot, thereby matching the speed of the ingrowing repair tissue [17,21,22,25,26] (B). GFs act as extracellular ligands by binding to transmembrane receptors arrayed on the surface of target cells, thereby activating intracellular signal transduction pathways that convey the signal to the nucleus to eventually induce a wide range of cell specifications during inflammation and the repair process including cell survival, proliferation, migration, differentiation, and maturation and changes in protein synthesis and metabolism (C). These effects include the synthesis and secretion of GFs and cytokines, which interact with their receptors in a diffusible manner (autocrine and paracrine pathways); the synthesis of extracellular matrix (ECM) components such as collagens, decorin, hyaluronic acid, and glycosaminoglycans; and cell survival, proliferation, differentiation, and migration (C) [17]. Only by understanding the unbreakable link between GFs and fibrin matrix will we grasp the in situ biological function of PRP and the additional pivotal fact that it is not necessary to combine this product with other delivery systems to slowdown the release of GFs.\">\n\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.btitrainingcenter.com\/wp-content\/uploads\/2021\/08\/ijms-22-00824-g001-200x200.jpg\" alt=\"\" width=\"200\" height=\"200\" \/>\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t<div class=\"qodef-ig-image qodef-item-space\">\n\t\t\t\t<div class=\"qodef-ig-image-inner\">\n\t\t\t\t\t\t\t\t\t\t\t<a itemprop=\"image\" class=\"qodef-ig-lightbox\" href=\"https:\/\/www.btitrainingcenter.com\/wp-content\/uploads\/2021\/08\/ijms-22-00824-g002.jpg\" data-rel=\"prettyPhoto[image_gallery_pretty_photo-199]\" title=\"&lt;strong&gt;Figure 02&lt;\/strong&gt; Summary of the primary biological and therapeutic features of platelet-rich plasma (PRP). PRP has emerged as an adjuvant human blood-derived constructs to assist tissue engineering and cell therapies in regenerative medicine. Figure adapted from [17] with permission.\">\n\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.btitrainingcenter.com\/wp-content\/uploads\/2021\/08\/ijms-22-00824-g002-200x200.jpg\" alt=\"\" width=\"200\" height=\"200\" \/>\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t\t\t<div class=\"qodef-ig-image qodef-item-space\">\n\t\t\t\t<div class=\"qodef-ig-image-inner\">\n\t\t\t\t\t\t\t\t\t\t\t<a itemprop=\"image\" class=\"qodef-ig-lightbox\" href=\"https:\/\/www.btitrainingcenter.com\/wp-content\/uploads\/2021\/08\/ijms-22-00824-g003.jpg\" data-rel=\"prettyPhoto[image_gallery_pretty_photo-199]\" title=\"&lt;strong&gt;Figure 03&lt;\/strong&gt; Achilles tendon rupture treatment: conservative and surgical treatment assisted by autologous blood or blood-derived products (PRP). (A) Achilles tendon rupture, rupture gap, and hematoma. (B) Conservative treatment: a single injection of either PRP or autologous blood injected into the gap hematoma. (C) Conservative treatment proposal (in patients with a low functional demand, or for whom surgery is contraindicated). Ultrasound-guided injection of 4 mL of liquid plasma rich in growth factors (PRGF) in close proximity to the apparently healthy tendon tissue at each stump of the tendon and 4\u20136 mL of liquid PRGF into the gap hematoma; a procedure to be repeated over 2 or 3 consecutive weeks (D\u2013F) Surgical treatment proposal: after the suture is performed with a non-reabsorbable suture material that has been bathed in liquid PRGF (D), 4\u20136 mL of liquid PRGF is injected in close proximity to the apparently healthy tendon tissue at each stump, as well as into the sutured area (E) within the time window of 10 to 15 min following PRGF activation with CaCl2. This window encompasses the time when the fibrin scaffold is still macroscopically liquid is but undergoing microscopic jellification. Liquid PRGF can extensively permeate through areas that surround the injection site and anchor to the collagen and other ECM proteins exposed in damaged tissue margins through the activated platelets conveyed by the fibrin clot, as a 3D fibrin\u2013extracellular matrix-like malleable structure [17], thereby bridging the gap of injured areas. The time window of 1\u20135 min is the result of the gel point or clotting time, meaning the change from liquid to solid undergone by the matrix when 15\u201320% of the fibrinogen has been incorporated into the gel by branching points (approximately 4 min 50 s) [46]. After closing the paratenon and prior to closing the overlying skin, the peritendinous regions are also infiltrated with PRGF; finally, the entire affected area of the tendon is covered with a fibrin membrane of PRGF (F). As general recommendation, we suggest the use of 10 mL Luer lock-type syringes with 21G needles, since the use of small syringes means that large pressures are exerted on the ECM of the tissue during infiltration, thereby accounting for the focalized disruption of the ECM components (a desirable effect in some treatment protocols aimed at disrupting the neovascularization and neoinnervation present in some chronic tendinopathies) [7,42]. Upon infiltration, the needle should be oriented as closely as possible parallel to, and longitudinal with, the tendon fascicles for an optimal diffusion of PRGF [42].\">\n\t\t\t\t\t\t\t\t\t\t\t<img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/www.btitrainingcenter.com\/wp-content\/uploads\/2021\/08\/ijms-22-00824-g003-200x200.jpg\" alt=\"\" width=\"200\" height=\"200\" \/>\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t\t<\/div>\n<\/div>[vc_empty_space height=&#8221;50px&#8221;][\/vc_column][\/vc_row][vc_row][vc_column]<a itemprop=\"url\" href=\"\/wp-content\/uploads\/2021\/08\/ijms-22-00824.pdf\" target=\"_blank\"  class=\"qodef-btn qodef-btn-medium qodef-btn-solid btnWebRosa2\"  >\n    <span class=\"qodef-btn-text\">Descarregar artigo<\/span>\n    <\/a>[\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"<p><strong>Int J Mol Sci. 2021 Jan 15;22(2):824.<\/strong> Achilles tendon ruptures are very common tendon ruptures and their incidence is increasing in modern society, resulting in work incapacity and months off sport, which generate a need for accelerated and successful therapeutic repair strategy. Platelet-rich plasma (PRP) is emerging as adjuvant human blood-derived constructs to assist Achilles tendon rupture treatment<\/p>\n","protected":false},"author":1,"featured_media":20032,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[158],"tags":[417,418,419,420],"class_list":["post-21402","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-medicina-regenerativa-pt-pt","tag-apnea-pt-pt","tag-implantologia-pt-pt","tag-medicina-pt-pt","tag-salud-pt-pt"],"acf":[],"_links":{"self":[{"href":"https:\/\/www.btitrainingcenter.com\/pt-pt\/wp-json\/wp\/v2\/posts\/21402","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.btitrainingcenter.com\/pt-pt\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.btitrainingcenter.com\/pt-pt\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.btitrainingcenter.com\/pt-pt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.btitrainingcenter.com\/pt-pt\/wp-json\/wp\/v2\/comments?post=21402"}],"version-history":[{"count":3,"href":"https:\/\/www.btitrainingcenter.com\/pt-pt\/wp-json\/wp\/v2\/posts\/21402\/revisions"}],"predecessor-version":[{"id":37600,"href":"https:\/\/www.btitrainingcenter.com\/pt-pt\/wp-json\/wp\/v2\/posts\/21402\/revisions\/37600"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.btitrainingcenter.com\/pt-pt\/wp-json\/wp\/v2\/media\/20032"}],"wp:attachment":[{"href":"https:\/\/www.btitrainingcenter.com\/pt-pt\/wp-json\/wp\/v2\/media?parent=21402"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.btitrainingcenter.com\/pt-pt\/wp-json\/wp\/v2\/categories?post=21402"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.btitrainingcenter.com\/pt-pt\/wp-json\/wp\/v2\/tags?post=21402"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}