Platelet-Poor Plasma for Muscle Injuries: A Review of Mechanisms and Clinical Perspectives.
Review
Overview
abstract
BACKGROUND: Muscle injuries are a frequent challenge in professional sports, with hamstring injuries being particularly prevalent. Despite advances in rehabilitation protocols, recurrence rates remain high, and recovery timelines vary depending on injury location and severity. PURPOSE: To examine the roles of platelet-rich plasma (PRP) and platelet-poor plasma (PPP) in muscle injury treatment, highlighting their biological differences and potential clinical applications. STUDY DESIGN: Narrative review. METHODS: A comprehensive literature search was conducted, focusing on the biological properties of PRP and PPP, their effects on muscle regeneration, and clinical outcomes related to their use in muscle injury management. RESULTS: PRP contains high concentrations of growth factors, including transforming growth factor-beta, myostatin, vascular endothelial growth factor, and platelet-derived growth factor, which promote cell proliferation and angiogenesis. However, its leukocyte content and associated pro-inflammatory cytokines may exacerbate inflammation, potentially increasing pain, delaying recovery, and raising the risk of heterotopic ossification. Conversely, PPP is rich in insulin-like growth factor-1 and hepatocyte growth factor, which modulate inflammation and fibrosis, promoting muscle regeneration. Basic science studies have demonstrated that PPP induces myoblast differentiation, whereas PRP primarily promotes myoblast proliferation, potentially favoring scar formation over true muscle tissue regeneration. Clinically, PPP has been explored as a treatment for muscle injuries, with some reports suggesting it may facilitate recovery and reduce reinjury risk. However, the limited availability of high-quality clinical trials prevents definitive conclusions about its efficacy compared with PRP. CONCLUSION: While both PRP and PPP offer biological advantages, PPP may present a favorable profile for muscle regeneration due to its ability to enhance differentiation while modulating inflammation. However, current clinical evidence remains limited, and further research is needed to establish definitive treatment guidelines.
