What Is the Role of Platelet-Derived Biologics? Editorial Summary This article explores the surgical strategy of platelet-derived orthobiologics, providing an overview of the benefits of their use and a consideration of the future of these products.
Introduction
O Prof Anand Pillai Consultant Orthopaedic Foot & Ankle and Adult Reconstruction Surgeon Manchester, United Kingdom
rthobiologics therapies have gained considerable interest in recent years. They are increasingly becoming popular for treatment of a variety of musculoskeletal pathologies. The term ‘biologic’ refers to a naturally occurring substance with the ability to heal, and ‘ortho’ refers to its application in musculoskeletal tissue. They are different from ‘biologic’ drugs commonly used now for treatment of rheumatological conditions. A wide array of orthobiologics are available but the broad categories of preparations include, but are not limited to: autologous blood products, cell-based therapies, and growth factors. In this article, various autologous blood products and their roles are discussed.1 Autologous blood products refers to any preparation derived from a patient’s whole blood. These include a range of products that can be further categorised into platelet-rich plasma (PRP), platelet poor-plasma (PPP) and autologous anti-inflammatory preparations (AAIs).2 Figure 1: Steps in preparation of PRP and PPP.
Dr Vish Kumar Consultant Orthopaedic Foot and Ankle Surgeon at Wye Valley NHS Trust & Spire Banks Hospital Worcester, United Kingdom
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Wound Masterclass - Vol 2 - December 2023
As ‘natural’ treatments, these products are an attractive option for both patients and clinicians as they eliminate concerns about immunogenic reactions and disease transmission. Platelet-rich plasma is a volume of plasma fraction of autologous blood having platelet concentrations above baseline where platelet count is usually 5 times higher than that of blood. PRP was first used to aid wound healing in 1987 after cardiac bypass surgery. It was first used in orthopaedics in 2003 for treatment of recalcitrant tennis elbow. PRP can be prepared in the laboratory, in the operating theatre or the clinic, from venous blood collected immediately before treatment. There are 3 techniques for PRP preparation: the gravitational platelet sequestration (GPS) technique, standard cell separators, and autologous selective filtration technology, also referred to as plateletpheresis. A small amount of PRP can be obtained in minutes using the GPS technique which is a table-top centrifuge system. For example, 5 ml of PRP volume can be prepared following a 12 minute spin at 3200 rpm using a GPS system.