Plasma Rich in Growth Factors for the Treatment of Skeletal Muscle Injury

Fig. 28.1.

Preparation of liquid PRGF®-Endoret®

2.

With ultrasound guidance, the injury and, if applicable, the possible hematoma associated with the muscle tear (seromas and fibrosis in the case of chronic injuries), are located.
3.

After locating the lesion, the area of skin to be infiltrated is prepared with a sterile field and antiseptic is applied; the area is demarcated with disposable cloths to perform ultrasound control in a comfortable way (the probe should be covered with a sterile cover) (Fig. 28.2). Next, hematoma, seroma, or cysts, if present, are then punctured/evacuated using a syringe (Fig. 28.3).

4.

Once the hematoma is evacuated, F2 is activated with calcium chloride (10 % wt/vol).
5.

PRGF-Endoret activated liquid formulation is injected into the injury site under ultrasound guidance (Fig. 28.4). The volume injected should be the maximum possible, depending on the size of the muscle, injury and severity. Although the amount of PRGF-Endoret infiltrated is usually 6–8 mL, volume can reach 10–15 mL.

6.

When the injury site has been infiltrated, it is necessary to conduct PRGF-Endoret infiltrations into the peripheral healthy muscle surrounding the injury, including interfascicular and interfibrillar regions. With these infiltrations, satellite cells are activated and mobilized, triggering muscle reparation processes and cell signaling pathways by activating endothelial cells, macrophages, and platelets. Infiltrations adjacent to the site of injury must be carried out systematically, for instance injury/stump, proximal-stump, distal-fascia, or deep and proximal interfascicular zone (Fig. 28.5).

7.

Finally, ice is applied to the infiltration area for about 10 min.

Fig. 28.2

Preparation of the sterile field required to perform ultrasound control, evacuation of hematoma if it exists, and infiltration of PRGF®-Endoret®

Fig. 28.3

The damaged regions are identified by ultrasound and the hematoma, if present, is then punctured and evacuated

Fig. 28.4

PRGF Endoret infiltration at the site injury and into surrounding (interfascicular and interfibrillar) areas with correct orientation of the needle

Fig. 28.5

A summary of the most important phases during percutaneous intramuscular infiltration of liquid activated PRGF®-Endoret®

Both clinical and ultrasound monitoring are performed weekly during patient follow-up to evaluate the potential need for more infiltrations. This decision is based on ultrasound images and any pain that the patient presents during this period. One or two sequential infiltrations (on a weekly basis) are usually sufficient, and more than three injections are not normally required. In addition, physiotherapy and rehabilitation treatment are mandatory since the limb has to be mobilized in an early and progressive manner. The mechanical stimulus leads to proper recovery of these patients, since it acts in a synergic ways with the biological effects of PRGF-Endoret [23, 24]. It does not, however, replace continued rehabilitation, but simply shortens the functional recovery times and stages. Complications such as seromas, cysts, or muscle fibrosis, have to be approached based on the same principles used in acute ruptures.

28.6 Conclusion

Despite the considerable evidence indicating that growth factors and fibrin matrix are instrumental in the muscle repair and regeneration process, there is a gap between basic science and clinical assessment in the treatment of muscle injuries. This gap should be bridged by performing clinical trials to evaluate the efficacy of PRGF for shortening the healing process and avoiding relapse.

References

Andia I, Sánchez M. Maffulli. Platelet rich plasma therapies for sports muscle injuries: any evidence behind clinical practice? Expert Opin Biol Ther. 2011;11:509–18.CrossRefPubMed

Anitua E, Andia I, Ardanza B, Nurden P, Nurden AT. Autologous platelets as a source of proteins for healing and tissue regeneration. Thromb Haemost. 2004;91:4–15.PubMed

Anitua E, Prado R, Sanchez M, Orive G. Platelet-rich plasma: preparation and formulation. Oper Tech Orthop. 2012;22:25–32.CrossRef

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