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Platelet-Rich Plasma Regenerative Medicine: Sports Medicine, Orthopedic, and Recovery of Musculoskeletal Injuries Lecture Notes in Bioengineering Lecture Notes in Bioengineering José Fábio Santos Duarte Lana Maria Helena Andrade Santana William Dias Belangero Angela Cristina Malheiros Luzo Editors Platelet-Rich Plasma Regenerative Medicine: Sports Medicine, Orthopedic, and Recovery of Musculoskeletal Injuries Lecture Notes in Bioengineering For further volumes: http://www.springer.com/series/11564 José Fábio Santos Duarte Lana Maria Helena Andrade Santana William Dias Belangero • Angela Cristina Malheiros Luzo Editors Platelet-Rich Plasma Regenerative Medicine: Sports Medicine, Orthopedic, and Recovery of Musculoskeletal Injuries 123 Editors José Fábio Santos Duarte Lana William Dias Belangero Research Institute of Sports Medicine Department of Orthopaedic and Orthopedics and Regeneration—iMOR Traumatology, Faculty of Medical Uberaba, MG Sciences Brazil University of Campinas Campinas, SP and Brazil Member of the Regenerative Angela Cristina Malheiros Luzo and Cell Therapy Group, Hemocentro Haematology and Hemotherapy Center University of Campinas, Unicamp Umbilical Cord Blood Bank Campinas, SP University of Campinas Brazil Campinas, SP Brazil Maria Helena Andrade Santana Department of Materials and Bioprocesses Engineering, School of Chemical Engineering University of Campinas Campinas, SP Brazil ISSN 2195-271X ISSN 2195-2728 (electronic) ISBN 978-3-642-40116-9 ISBN 978-3-642-40117-6 (eBook) DOI 10.1007/978-3-642-40117-6 Springer Heidelberg New York Dordrecht London Library of Congress Control Number: 2013950744 Ó Springer-Verlag Berlin Heidelberg 2014 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. Exempted from this legal reservation are brief excerpts in connection with reviews or scholarly analysis or material supplied specifically for the purpose of being entered and executed on a computer system, for exclusive use by the purchaser of the work. Duplication of this publication or parts thereof is permitted only under the provisions of the Copyright Law of the Publisher’s location, in its current version, and permission for use must always be obtained from Springer. Permissions for use may be obtained through RightsLink at the Copyright Clearance Center. Violations are liable to prosecution under the respective Copyright Law. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. While the advice and information in this book are believed to be true and accurate at the date of publication, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) Foreword I When the editors of this book invited me to write these lines, I asked myself what I could offer to arouse or increase the reader’s interest. I thought a comparison with the history of the initiation of other treatments as controversial as this one could be the key. Orthopaedic Surgery underwent a big change when fractures that had previ- ously been treated conservatively started being treated surgically. The aim was to ensure two things: first get a better fracture reduction, and secondly, to ensure better cohesion-congruency of the fragments and by so doing allow for earlier mobility. There were those that argued for and against this approach but over time the advantages that fracture osteosynthesis brings became highlighted. Years later a similar event occurred when endoscopic surgery was developing in the respiratory, digestive, and renal systems; it reached the joints and in the first third of the twentieth century it became possible to visualize the inside of the knee. Thus began articular endoscopic surgery with many differences of opinion and was only supported by a few, while many others did not believe in the benefits it could bring. Acceptance of this surgical treatment took many years and only began to be taken advantage of in the 1950s. However, over time and after many studies the aforementioned surgical tech- nique has become routine for intraarticular surgery. The acquisition of knowledge by orthopedic surgeons, the design of new instruments and more accurate diag- nosis of intra-articular pathologies have allowed this surgical technique to offer more solutions and therefore become more and more popular. Now it is biological therapies that are under the spotlight in the scientific community. Evidence-based medicine, good for the level of excellence that it demands, making it necessary to perform a lot of research to substantiate the effectiveness of treatments mentioned can be broadly divided into three groups: • those using the implantation of a biological inducer (Scaffold); • those that use substances that create favorable environments for the develop- ment of cells (Growth Factors); • and those that implant cells in one step or two, with the difference between the two being the culture of cells (two steps with a greater number of cells) or (one step with a lower number). v vi Foreword I I hope this short tour through the history of Orthopaedic Surgery and this brief summary of biological therapies serve to encourage the reader to delve into the exciting world of tissue regeneration. I would like to give my most sincere congratulations to the editors for the work they have done. Barcelona, April 2013 Ramon Cugat Foreword II Platelet Rich Plasma (PRP) is now gaining international recognition as a treatment modality. PRP came into existence during the 1980s and has since been used in many areas of medicine. My exposure to PRP and Regenerative Medicine began during my Sports Medicine Fellowship at South Pointe Cleveland Clinic, with Dr. Zenos Vangelos. The Orthobiologic premise of helping to facilitate healing of tissue had tremen- dous appeal to me. Having also experienced PRP treatments, I can speak of the effective treatment outcome, which I have now seen replicated in thousands of my patients. To date, there have been thousands of research studies published on the topic of PRP, yet as with many relatively new treatments, there are often many more questions than answers. This challenge has galvanized our authors to provide the first complete textbook on Platelet Rich Plasma. This comprehensive textbook lists the most current thoughts on PRP basic science, surgical applications, and non-surgical applications. In doing so, it is our hope that this textbook will help provide answers to some of these difficult questions and serve as a springboard for further research in this treatment modality. I would like to thank Dr. Steven Sampson for his kind invitation to be a part of this endeavor and Dr. José Fábio Santos Duarte Lana for compiling an outstanding group of internationally renowned authors in this groundbreaking textbook on Platelet Rich Plasma. Special thanks to my wife Yael, for being very understanding, supportive, and loving. Adam Weglein vii Foreword III Regenerative Medicine holds tremendous promise and is quickly gaining popu- larity worldwide. With today’s global communication, leading physicians are creating a community to foster development of innovative therapies. Although publishing literature as a clinician is tedious and challenging, it is critical to share our experiences with one another to advance our understanding of ‘‘orthobiologic’’ treatments. Dr. José Fábio Santos Duarte Lana, a world renowned orthopedist, should be commended for assembling such an international collaborative effort with physicians and researchers. Currently there are few, if any, medical textbooks that attempt to cover the span of regenerative medicine techniques in orthopedic medicine. As clinicians in our respective offices we practice the art of medicine daily. Often times when it comes to regenerative medicine we must become ‘‘pioneers’’ deciding on protocols that have not been laid out before us. For example, when I first began using PRP (Platelet Rich Plasma) for knee osteoarthritis there was no evidence-based medi- cine or guidelines to follow. I was driven to help patients that have failed all of the current treatment options and the science theoretically made sense. Several years later this textbook may serve as a reference for new doctors or ‘‘pioneers’’ to follow and to stimulate creativity and further evolution of this most exciting field. After using PRP to treat thousands of patients with complex conditions, we continue to modify our protocols and ask more questions. Every month new research is emerging, adding to our understanding of this novel therapy. This text addresses the growing need for standardization of technique and platelet prepa- ration when assessing its validity for clinical outcomes. While science has allowed us to greatly understand that platelets may amplify tenocytes or chondrocytes in vitro, we are now just collecting robust data in the clinical realm. Most physicians implementing
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