Autologous Conditioned Plasma

from Wikipedia, the free encyclopedia

Autologous conditioned plasma (ACP) is platelet-rich plasma that is obtained from autologous blood by centrifugation and can support regeneration in numerous orthopedic diseases and procedures.

description

With a growing number of orthopedic treatments (e.g. tendon and ligament injuries, torn muscle fibers , osteoarthritis ) autologous blood products are attracting increasing interest. With this type of therapy, the body's own active ingredients, the so-called growth factors , support healing.

definition

Autologous conditioned plasma (ACP) is the body's own (autologous) blood plasma that is conditioned by a special process, i.e. H. is largely separated and concentrated from the remaining blood components (e.g. erythrocytes ). The ACP is a platelet-rich plasma (PRP - platelet-rich plasma ). PRP is a general name for a plasma obtained from whole blood by a separation process with an increased number of platelets (compared to whole blood). The main components of ACP are thrombocytes (blood platelets) and numerous growth factors that play an important role in healing. In contrast to other platelet-rich plasma preparations, ACP is characterized by a low concentration of white blood cells (e.g. neutrophil granulocytes ), which in high concentrations can hinder the healing process.

Manufacturing

The ACP is obtained from autologous blood. To do this, a small amount of blood (10-15 ml) is taken from the arm vein, analogous to a blood test . In a second step, the ACP is separated from the remaining blood components using a centrifuge . A brief centrifugation at a low speed is sufficient for this. In the next step, the ACP can be removed as a transparent protrusion. Various manufacturers offer special syringe systems with which the blood is extracted from the patient, conditioned and then injected back into the region to be treated. The blood product remains in the syringe system during the entire process, which offers the highest possible level of protection against contamination .

application

Healing can be supported by ACP for injuries to the musculoskeletal system , ligaments and tendons , but also for muscle injuries or tendinitis . Tests in the laboratory have shown a significant increase in the cell division activity of muscle, tendon and bone cells. In addition, the effectiveness of ACP in various areas of application has been shown in numerous clinical studies. ACP will u. a. Also used for injuries in top-class sport, for example in the football and basketball league for the treatment of injured athletes.

Examples of indications - acute

  • Ligament injury including cruciate ligament, ligaments of the ankle
  • fracture
  • Muscle fiber and meniscus injury
  • Tendon injury including Achilles tendon, rotator cuff

Examples of indications - chronic

effect

The healing of injured tissue goes through a complex series of natural processes. The growth factors that initiate or regulate these complex processes play a key role in this. Many of these growth factors are released from platelets that are in the blood and activated when injured. Since cells or tissue are destroyed in an injury or inflammation, growth factors such as B. Platelet Derived Growth Factor (PDGF), Transforming growth factor (TGF), Fibroblast Growth Factor (bFGF) and Vascular Endothelial Growth Factor (VEGF) that are involved in cellular processes that support healing and are related to growth of Tissues stand. They initiate the proliferation and differentiation of different cell types (e.g. osteoblasts and chondroblasts ), promote matrix formation through collagen and proteoglycan production and stimulate angiogenesis . On the other hand, there is the immune response controlled by leukocytes / neutrophils , which is involved in the breakdown of damaged tissue and counteracts possible infections by means of free radicals (radical oxygen species, ROS), proteases and antimicrobial peptides. However, these have the biological potential to damage healthy tissue. By administering ACP at the site of action, an increased platelet concentration (2-3 times compared to whole blood) is applied in the almost complete absence of neutrophils, which means that the body's own healing d. H. The formation of blood vessels, new cells and tissue is supported and painful inflammatory processes are inhibited.

Studies

Achilles tendon rupture : In 2019, a group of British scientists led by the University of Oxford investigated whether a single local injection of so-called platelet-rich plasma (A-PRP) supports the healing of a fresh medial Achilles tendon rupture . All patients received an immobilizing bandage for 3, a maximum of 6 weeks and slowly building up physiotherapy. The platelet-rich plasma was also injected once into the heel of one half, while the other half (controls) received a puncture with an empty syringe (sham intervention). No significant differences were found between the two groups in any of the endpoints investigated on the function of the joint or the duration and intensity of pain. A new tendon rupture occurred in 5% of the intervention group and 3% in the control group. The pharmaceutical letter concluded: "In the largest study to date on the injection of autologous platelet-rich plasma (" autologous blood injection ") to support the conservative treatment of complete medial Achilles tendon ruptures, no benefit compared to placebo could be demonstrated".

Individual evidence

  1. ↑ Augustus D. Mazzocca: Platelet-Rich Plasma Differs .According to Preparation Method and Human Variability. In: J Bone Joint Surg Am . 94, 2012, pp. 308-316.
  2. ↑ Emily A. Sundman: Growth Factor and Catabolic Cytokine Concentrations Are Influenced by the Cellular Composition of Platelet-Rich Plasma. In: Am J Sports Med. PreView. August 16, 2011.
  3. ↑ Augustus D. Mazzocca: The Positive Effects of Different Platelet-Rich Plasma Methods on Human Muscle, Bone, and Tendon Cells. In: Am J Sports Med. 40, 2012, pp. 1742-1749.
  4. ↑ F. Cerza et al .: Comparison Between HyaluronicAcid and Platelet-Rich Plasma, Intra-articular Infiltration in the Treatment of Gonarthrosis. In: The American Journal of Sports Medicine. online published on October 25, 2012.
  5. ^ VM Deans, A. Miller, J. Ramos: A Prospective Series of Patients with Chronic Achilles Tendinopathy Treated with Autologous-conditioned Plasma Injections Combined with Exercise and Therapeutic Ultrasonography. In: The Journal of Foot and Ankle Surgery. 51 (6), 2012, pp. 706-710.
  6. ↑ PA Smith: Intra-articular Autologous Conditioned Plasma Injections Provide Safe and Efficacious Treatment for Knee Osteoarthritis . In: The American Journal of Sports Medicine . 2016; 44 (4): 884-91.
  7. ^ BJ Cole et al .: Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis . In: The American Journal of Sports Medicine (2017); 45 (2): 339-46.
  8. ↑ RD Ford et al: A retrospective comparison of the management of recalcitrant lateral elbow tendinosis: platelet-rich plasma injections versus surgery . Hand (NY). 2015; 10 (2): 285-91.
  9. ^ R. Lebiedzinski et al .: A randomized study of autologous conditioned plasma and steroid injections in the treatment of lateral epicondylitis. International Orthopedics. 2015; 39 (11): 2199-203.
  10. ↑ KT Chew et al .: Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomized trial. PM&R. 2013; 5 (12): 1035-43.
  11. ↑ R. Zayni et al .: Platelet-rich plasma as a treatment for chronic patellar tendinopathy: comparison of a single versus two consecutive injections. In: Muscles Ligaments Tendons Journal. 2015; 5 (2): 92-8.
  12. ↑ R. Erbeldinger, M. Sabok Sir, Dr. med. C. Lukas, Dr. med. K. Fehske: Treatment of Overuse Syndromes . Sportärztezeitung, February 2018, accessed on November 12, 2018 .
  13. ↑ R. Erbeldinger, Dr. med. J. Enneper: Survey of team doctors - treatment of muscle tendon injuries. Sportärztezeitung, January 2018, accessed on November 12, 2018 .
  14. ↑ a b c Isabel Andia: Basic Science: Molecular and Biological Aspects of Platelet-Rich Plasma Therapies. In: Oper Tech Orthop. 22, 2012, pp. 3-9.
  15. ↑ P. Borzini, L. Mazzucco: Tissue Regeneration and in Loco Administration of Platelet Derivates: Clinical Outcomes, Heterogeneous Products, and Heterogeneity of Effector Mechanisms. In: transfusion . 45, 2005, pp. 1759-1767.
  16. ↑ D. Edwards et al: Transforming Growth Factor Beta Modulates the Expression of Collagenase and Metalloproteinase Inhibitor. In: The EMBO Journal . 6 (7), 1987, pp. 1899-1904.
  17. ^ S. Lynch et al.: Role of Platelet-derived Growth Factor in Wound Healing: Synergistic Effects with Other Growth Factors. In: Proc. Natl. Acad. Sci. USA . 84, 1987, pp. 7696-7700.
  18. ^ F. Graziani et al: The In Vitro Effect of Different PRP Concentrations on Osteoblasts and Fibroblasts. In: Clin Oral Implant Res . 17 (2), 2006, pp. 212-219.
  19. ↑ Keene, DJ, et al .: Platelet rich plasma in Achilles Tendon Healing-2 (PATH-2 Trial) . In: British Medical Journal . tape 367 , 2019, pp. l6132 .
  20. ↑ Injections of autologous blood are no more effective than placebo injections in the case of ruptured Achilles tendon . In: Ludwig WD, Schuler J (ed.): The drug letter . tape 54 . Westkreuz Verlag, Berlin 2019, p. 07A .

Web links