The main focus of sports medicine is the treatment of acute and chronic injuries resulting from physical exercise. Many of these injuries are difficult to treat because they involve cartilage or soft tissues (e.g., muscles, tendons, ligaments) that naturally have a very limited capacity for healing. There is a growing body of clinical evidence examining the use of Mesenchymal Stem Cells (MSCs) and Platelet-rich Plasma (PRP) to support their use in sports related injuries.1
Benefits of Bone Marrow-derived MSCs in Sports Medicine
When a muscle, joint, or bone suffers an injury, the first stage of the body’s response is usually an inflammatory reaction that involves increased blood flow to the area and an influx of immune cells. This initial inflammation is useful in the early stages of injury, to stabilize the injured tissue and destroy any pathogens that may have been introduced into the body. However, in order for the next stage of repair and regeneration to proceed, the inflammatory reaction must start to subside. MSCs play a key role in this process by producing growth factors and anti-inflammatory proteins that decrease the activity of inflammatory immune cells and regulate the tissue environment so that healing processes can start. Since MSCs can also differentiate into several of the key cell types involved in musculoskeletal injuries, they can also play a direct role in rebuilding the damaged tissues once inflammation has subsided and healing has begun.1
Evidence from pre-clinical studies is being translated to the clinic, with the use of MSCs for human tissue injury.1 One study examining recovery from rotator cuff injuries found that the local introduction of autologous MSCs significantly improved the speed and durability of healing. At 6 months, all of the tears treated with MSCs had healed, compared with roughly two-thirds of those that did not receive MSC therapy; over a 10-year follow-up, only 13% of patients treated with MSCs suffered another injury to the same area, compared to 56% of patients in the control group.2
Platelet-Rich Plasma (PRP) in Sports Medicine
Since PRP contains a wide range of components that promote cellular differentiation, tissue healing, and recruitment of MSCs and other repair-related cells, it also has the potential to accelerate the healing of acute and chronic musculoskeletal injuries.1
Within sports medicine, PRP has been most extensively studied for the treatment of lateral epicondylitis, also known as “tennis elbow”. Double-blind randomized studies have shown that PRP is more effective than standard corticosteroid treatment for improving function and reducing pain3, and more effective than injections of the local anesthetic bupivacaine for reducing long-term pain.4
Individual case studies and a prospective case series have also shown that PRP reduces pain and improves function in patients with rotator cuff injuries.5
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2. Hernigou P et al. Biologic augmentation of rotator cuff repair with mesenchymal stem cells during arthroscopy improves healing and prevents further tears: a case-controlled study. Int Orthop 2014;38:1811–1818.
3. Peerbooms JC et al. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med 2010;38:255–262.
4. Mishra AK et al. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. American Journal of Sports Medicine 2014;42(2):463–471.
5. Taylor DW et al. A systematic review of the use of platelet-rich plasma in sports medicine as a new treatment for tendon and ligament injuries. Clin J Sport Med 2011;21:344–352.
6. Pers YM et al. Mesenchymal stem cells for the management of inflammation in osteoarthritis: state of the art and perspectives. Osteoarthritis and Cartilage 2015;23:2027–2035.
7. Wolfstadt JI et al. Current concepts: the role of mesenchymal stem cells in the management of knee osteoarthritis. Sports Health 2015;7:38–44.
8. Gobbi A et al. One-step surgery with multipotent stem cells for the treatment of large full-thickness chondral defects of the knee. Am J Sports Med 2014;42:648–657
9. Gobbi A et al. Matrix-induced autologous chondrocyte implantation versus multipotent stem cells for the treatment of large patellofemoral chondral lesions: a nonrandomized prospective trial. Cartilage 2015;6:82–97.
10. Campbell KA et al. Does intra-articular platelet-rich plasma injection provide clinically superior outcomes compared with other therapies in the treatment of knee osteoarthritis? A systematic review of overlapping meta-analyses. Arthroscopy 2015;31:2213–2221.
11. Lin KY et al. Intra-articular injection of platelet-rich plasma is superior to hyaluronic acid or saline solution in the treatment of mild to moderate knee osteoarthritis: a randomized, double-blind, triple-parallel, placebo-controlled clinical trial. Arthroscopy 2019;35:106–117.
12. Cook CS et al. Clinical update: Why prp should be your first choice for injection therapy in treating osteoarthritis of the knee. Curr Rev Musculoskelet Med 2018;11:583–592.