Int J Immunopathol Pharmacol. 2012 Apr-Jun;25(2):325-34. doi: 10.1177/039463201202500202.
Tendinopathies are very common in athletes and in people practicing sport activities. The experimental evidence that growth factors (GFs), present in platelets, enhance the recruitment, proliferation and differentiation of cells involved in tissue regeneration, has prompted the use of platelet rich plasma (PRP) preparations in the treatment of these diseases. However, at present, a sound demonstration of the clinical efficacy of PRP is still lacking. Several theoretical and practical reasons can explain the failure of the treatment: a) animal experiments have been carried out on normal tendons submitted to surgical lesions, and it is questionable whether these models may best mimic human pathology; b) the pathway of chronic tendinopathies is very complex, involving, besides GFs, many other pathogenetic factors, which operate at different stages of the disease; c) several methods have been used to produce PRP, which can result in a large variation in GF content, and in kinetics of release. Therefore, further research is desirable. As a preliminary step, it is necessary to standardize PRP preparation, and to establish the modalities of its activation and administration. Secondly, prospective, randomized, double-blind studies are needed, selecting subjects with homogenous forms of tendinopathies: load-bearing and non-load-bearing tendons, midportion and insertional tendinopathies, with or without neovascularization. Finally, new strategies in PRP use should be exploited: among them, the association of PRP with autologous stem cells or the administration of selective GFs (fibroblast growth factor, vascular endothelial growth factor, or anti-angiogenic factors), which could be better options in specific situations.
腱病在运动员和运动爱好者中非常常见。实验证据表明，存在于血小板中的生长因子（GFs）可增强参与组织再生的细胞的募集、增殖和分化，这促使人们将富含血小板的血浆（PRP）制剂用于治疗这些疾病。然而，目前仍然缺乏对 PRP 临床疗效的有力证明。有几个理论和实际的原因可以解释这种治疗的失败：a）动物实验是在正常肌腱接受手术损伤的情况下进行的，这些模型是否能最好地模拟人类病理学是值得怀疑的；b）慢性腱病的发病机制非常复杂，除了 GFs 之外，还涉及许多其他致病因素，这些因素在疾病的不同阶段发挥作用；c）已经使用了几种方法来制备 PRP，这可能导致 GF 含量和释放动力学的巨大变化。因此，需要进一步的研究。作为初步步骤，有必要标准化 PRP 的制备，并确定其激活和给药方式。其次，需要进行前瞻性、随机、双盲研究，选择具有同质腱病形式的受试者：承重和非承重肌腱、中段和插入部腱病，有或没有新生血管形成。最后，应该利用 PRP 使用的新策略：其中，PRP 与自体干细胞联合使用或给予选择性 GFs（成纤维细胞生长因子、血管内皮生长因子或抗血管生成因子），在特定情况下可能是更好的选择。
