Original Article
Corticosteroids and Local Anesthetics Decrease Positive Effects of Platelet-Rich Plasma: An In Vitro Study on Human Tendon Cells

https://doi.org/10.1016/j.arthro.2011.09.013Get rights and content

Purpose

To determine the effects of mixing anesthetics or corticosteroids with platelet-rich plasma (PRP) on human tenocytes in vitro.

Methods

Two separate protocols (double spin and single spin) were used to obtain homologous PRP from the blood of 8 healthy volunteers. Discarded tendon acquired during biceps tenodesis served as tendon specimens for all experiments. After cell isolation, tenocytes were treated in culture with PRP alone or in combination with corticosteroids and/or anesthetics. Fetal bovine serum in concentrations of 2% and 10% served as controls. Cell exposure times of 5, 10, and 30 minutes were used. Radioactive thymidine and luminescence assays were obtained to examine cell proliferation and viability.

Results

The presence of lidocaine, bupivacaine, or methylprednisolone resulted in significantly less proliferation than the negative 2% fetal bovine serum control (P < .05). When we compared groups, both lidocaine and bupivacaine had a greater inhibitory effect than methylprednisolone (P < .05). At all time points, viability was significantly decreased in the presence of lidocaine, bupivacaine, or methylprednisolone compared with the negative control (P < .05).

Conclusions

The addition of either anesthetics or corticosteroids to PRP resulted in statistically significant decreases in tenocyte proliferation and cell viability. These results suggest that incorporation of anesthetics or corticosteroids, either alone or in combination, with PRP injection may compromise the potentially beneficial in vitro effects of isolated PRP on tendon cells and compromise cell viability at the site of tendon injury.

Clinical Relevance

Anesthetics or corticosteroids either alone or in combination should be used carefully to preserve the proposed positive effects of PRP in the treatment of tendon injury.

Section snippets

Plasma Concentrates

Venous blood was collected from 8 healthy volunteers (2 women and 6 men) with a mean age of 31.7 ± 11.1 years (Institutional Review Board No. 10-204-2). To obtain PRP, 2 separate isolation protocols were used: single spin (PRPSS) and double spin (PRPDS). These protocols were selected to reflect current clinical practice.3

Plasma Concentrates

The preparation of platelets increased the platelet number in the PRPSS group on average to 2.6 times the baseline concentration of whole blood, whereas the platelet number in the PRPDS group was on average 3.3 times the concentration of whole blood. White blood cell concentrations in both the PRPSS group and the PRPDS group were decreased at least 10-fold in comparison with the concentration in whole blood samples (Table 1).

Analysis of Cell Proliferation

There were several significant findings among both the control and

Discussion

This study was designed to provide in vitro data to clinicians who are interested in combining PRP with anesthetics or corticosteroids. With regard to our hypothesis, tenocyte proliferation and viability were increased when PRPSS and PRPDS preparations were added to the tenocyte culture. Conversely, tenocyte proliferation and viability were substantially decreased when anesthetics and corticosteroids were added. Combined treatment, using PRP preparations and anesthetics or corticoids, showed a

Conclusions

The addition of either anesthetics or corticosteroids to PRP resulted in statistically significant decreases in tenocyte proliferation and cell viability. These results suggest that incorporation of anesthetics or corticosteroids, either alone or in combination, with PRP injection may compromise the potentially beneficial in vitro effects of isolated PRP on tendon cells and compromise cell viability at the site of tendon injury.

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  • Cited by (0)

    The authors report the following potential conflict of interest or source of funding in relation to this article: The University of Connecticut Health Center/New England Musculoskeletal Institute has received direct funding and material support for this study from Arthrex Inc., Naples, FL.

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