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Plasma rico em plaquetas : alternativa terapêutica em tendinopatias crónicas
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Resumo(s)
As propriedades regenerativas das plaquetas através da libertação local de factores de crescimento têm sido utilizadas recentemente na prática clínica, sob a forma de Plasma Rico em Plaquetas, como adjuvantes no tratamento de diferentes patologias músculo-esqueléticas, com destaque para as lesões dos tendões.
Esta revisão sistemática da literatura tem como objectivo analisar os resultados de estudos realizados em humanos, que avaliam o impacto deste tipo de terapêuticas nas tendinopatias mais comuns (tendinopatia do tendão de Aquiles, do tendão rotuliano, da coifa dos rotadores e epicondilites), bem como dar uma perspectiva geral dos seus mecanismos de acção, métodos de obtenção e sistemas de classificação.
A evidência científica não parece suportar a utilização de PRP como tratamento de primeira linha nas tendinopatias. No entanto, as terapêuticas baseadas em PRP podem ser consideradas em subtipos específicos de tendinopatias, com destaque para as lesões do tendão rotuliano, onde as evidências parecem suportar a utilização de múltiplas injecções de PRP sobre controlo ecográfico no tratamento desta patologia após falha do tratamento conservador de 1ª linha.
A grande conclusão deste trabalho de revisão consiste na necessidade da realização de mais estudos com elevado grau de evidência, bem como a uniformização dos parâmetros que diminuam o viés na sua comparação, com o intuito de se formularem recomendações específicas acerca da pertinência da utilização do PRP e das suas aplicações específicas.
The regenerative properties of platelets through the local release of growth factors have recently been used in clinical practice, with products derived from Platelet Rich Plasma, as adjuvants in the treatment of various musculoskeletal diseases, especially tendon injuries. This systematic literature review aims to analyze the results of human studies that assess the impact of such therapies in the most common forms of tendinopathy (tendinopathy of the Achilles tendon, patellar tendon, rotator cuff and epicondylitis) and give an overview of their mechanisms of action, obtaining methods and classification systems. The scientific evidence does not seem to support the use of PRP as first-line treatment in tendinopathy. However, therapies based on PRP may be considered in specific subtypes of tendinopathy, with emphasis on the patellar tendon injuries, where the evidence seems to support the use of multiple PRP injections on ultrasound control in the treatment of this disease after failure of conservative first line treatment. The major conclusion of this review is the need of further studies with a high degree of evidence as well as the standardization of parameters that minimize bias in their comparison in order to formulate specific recommendations about the relevance of the use of PRP and its applications.
The regenerative properties of platelets through the local release of growth factors have recently been used in clinical practice, with products derived from Platelet Rich Plasma, as adjuvants in the treatment of various musculoskeletal diseases, especially tendon injuries. This systematic literature review aims to analyze the results of human studies that assess the impact of such therapies in the most common forms of tendinopathy (tendinopathy of the Achilles tendon, patellar tendon, rotator cuff and epicondylitis) and give an overview of their mechanisms of action, obtaining methods and classification systems. The scientific evidence does not seem to support the use of PRP as first-line treatment in tendinopathy. However, therapies based on PRP may be considered in specific subtypes of tendinopathy, with emphasis on the patellar tendon injuries, where the evidence seems to support the use of multiple PRP injections on ultrasound control in the treatment of this disease after failure of conservative first line treatment. The major conclusion of this review is the need of further studies with a high degree of evidence as well as the standardization of parameters that minimize bias in their comparison in order to formulate specific recommendations about the relevance of the use of PRP and its applications.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2016
Palavras-chave
Plasma rico em plaquetas Tendinopatia Epicondilite Tendão rotuliano Tendão de aquiles Coifa dos rotadores