1. Platelet rich Plasma Dr.Syed Imran

2. Definition Platelet rich plasma (PRP), also termed autologous platelet gel, plasma rich in growth factors (PRGF) increased concentration of autologous platelets suspended in a small amount of plasma

3. Procurement centrifuged at varying speeds until it separates into 3 layers 1.PPP 2.Red fraction 3.PRP ( highest specific gravity)

4. Contents TGF Beta PDGF IGF VEGF EGF FGF-2

5. Uses Sports medicine Orthopaedics Traumatology General surgery Dentistry Cosmetology

6. Sports medicine tendons, ligaments and muscles Tennis elbow golf elbow Achilles tendon damage plantar fasciitis rotator cuff syndrome adductor muscle enthesopathy jumper’s knee runner‘s knee,

7. most predisposed to Achilles tendon damage take part in running, badminton, squash or cold weather training

8. considered as a secondary step of treatment, occurring after or in association with physiotherapy, eccentric training and manual therapy, but prior to surgery, or in order to avoid such procedures as open tendon cleaning or the more widely used Achilles tendon tendoscopy

9. Arthroscopic uses increase the efficiency of healing grafts in anterior cruciate ligament reconstructive knee surgery. to revitalize the graft employed in anterior cruciate ligament reconstruction in the case of its failure. If the continuity of the graft structure is maintained,albeit with weakened mechanical integrity during the arthroscopic procedure

10. attempts to use PRP in the treatment of articular surface damage fractures, pseudoarthritis, skeletal reconstructions, in joint replacements, as well as fibrous dysplasia and bone inflammation (Franchini et al., 2005). Kawasumi et al. Describe the use of PRP in the treatment of chronic inflammations of the bones

11. In most cases, they observed permanent healing of wounds and no recurrence of infection for at least a year. Bielecki et al. confirmed the bacteriostatic and bactericidal properties

12. Bone healing Many of these factors have shown to enhance osteogenesis PDGF,FGF,EGF :Stimulate osteoblastic progenitors TGF-Beta increases matrix synthesis (type 1 collagen ) VEGF FGF-2 Angiogenic factors

13. Effect of PRP or PDGF on clot microenvironment might be positive or negative Depends on clinical setting,graft site local environment

14. Recent in vitro studies suggest that PRP can inhibit BMP’s They are not a source of osteogenic cells Their effects depend on presence of osteogenic population

15. Effectiveness ??? Donor dependent Composition depends on preparation method Outcomes are not uniform

16. FAQ How to adminster ?

17. How many injections ? Duration between injections ?

18. Any side effects ?

19. Can be availed by all ? Severe anemia, low platelet count, abnormal platelet function, active systemic infection or active cancer are all contra- indications

20. Availability in India ? Cost ???

21. Interleukin-6 Elevated serum IL-6 levels 12 hours after trauma correlated with an increased likelihood of having FES develop; no significant relationship was observed between IL-6 levels at 6 or 24 hours and the development of FES.

22. Patients with FES had a mean IL-6 level of 131 pg/mL, whereas those without FES had a mean IL-6 level of 72 pg/mL. Peak IL-6 levels were observed at 12 hours.

23. IL-6 is one of the most important cytokine in acute inflammatory phase and is released very early in inflammatory process.

24. Although there are many inflammatory markers, we selected IL-6 as a marker for a few reasons. Firstly the ELISA kit for measuring IL-6 required 0.5 mls of blood for each measurement. Secondly, IL-6 is an inflammatory marker that is activated in the early phase of the acute inflammatory response.

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