BlueCross BlueShield of Tennessee Medical Policy Manual

Platelet Rich Plasma as a Treatment for Wound Healing or Other Conditions

DESCRIPTION

Autologous platelet concentrate suspended in plasma, also known as platelet-rich plasma (PRP), can be prepared from samples of centrifuged autologous blood. Exposure to a solution of thrombin and calcium chloride degranulates platelets, releasing the various growth factors resulting in the polymerization of fibrin from fibrinogen, creating a platelet gel. The platelet gel can then be applied to wounds or may be used as an adjunct to surgery to promote hemostasis and accelerate healing.

PRP has been investigated as an adjunct to a variety of periodontal, reconstructive, and orthopedic procedures. For example, bone morphogenetic proteins are a type of transforming growth factors, and thus PRP has been used in conjunction with bone-replacement grafting (using either autologous grafts or bovine-derived xenograft) in periodontal and maxillofacial surgeries. Alternatively, PRP may be injected directly into the tissue. PRP has also been proposed as a primary treatment of other conditions, such as epicondylitis, plantar fasciitis, and Dupuytren’s contracture. Some providers combine platelet-rich plasma with adipose cells, in addition, other agents may be added to the mix; the solution is then injected into various locations on the body. Some providers refer to this procedure as “fat graft stem cell treatment”; however, a legitimate stem cell transplant involves a much more complicated set of procedures.

There are a number of commercially available centrifugation devices that are approved by the U. S. Food and Drug Administration (FDA) and are used for the preparation of platelet rich plasma. However, these devices must be labeled as following: “The platelet rich plasma prepared by this device has not been evaluated for any clinical indications.”

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION 

Current results of trials using PRP are mixed and the studies are limited in both size and quality. The evidence is insufficient to determine the effects of this technology on health outcomes.

SOURCES 

American Academy of Orthopaedic Surgeons. Treatment of osteoarthritis of the knee - evidence-based guideline 2nd edition. Retrieved October 3, 2018 from https://www.aaos.org.

BlueCross BlueShield Association. Evidence Positioning System. (2:2019). Recombinant and autologous platelet-derived growth factors for wound healing and other non-orthopedic conditions (2.01.16). Retrieved September 23, 2019 from https://www.evidencepositioningsystem.com/. (37 articles and/or guidelines reviewed)

BlueCross BlueShield Association. Evidence Positioning System. (5:2019). Orthopedic applications of platelet-rich plasma (2.01.98). Retrieved September 23, 2019 from https://www.evidencepositioningsystem.com/. (47 articles and/or guidelines reviewed)

Centers for Medicare & Medicaid Services. CMS.gov. NCD for platelet-derived wound healing formula (270.3). Retrieved January 26, 2016 from http://www.cms.gov.

de Souza, T.E., de Castro, T.F., Michellon, F.C., Passoni, A.C.C., Ortega, L.J.A., Iwaki, L.C.V., & da Siva, M.C. (2019). Adjuvant therapies in the management of medication-related osteonecrosis of the jaws: systematic review. Head & Neck, doi: 10.1002/hed.25944. [Epub ahead of print]. Abstract retrieved September 23, 2019 from PubMed database.

Di Matteo, B., Loibl, M., Andriolo, L., Filardo, G., Zellner, J., Koch, M., & Angele, P., (2016). Biologic agents for anterior cruciate ligament healing: a systematic review. World Journal of Orthopedics, 7 (9), 592-603. (Level 1 evidence)

Fitzpatrick, J., Bulsara, M., & Zheng, M. (2017). The effectiveness of platelet-rich plasma in the treatment of tendinopathy: a meta-analysis of randomized controlled clinical trials. American Journal of Sports Medicine, 45 (1), 226-233. Abstract retrieved September 23, 2019 from PubMed database.

Franchini, M., Cruciani, M., Mengoli, C., Marano, G., Pupella, S., Veropalumbo, E., et al. (2018). Efficacy of platelet-rich plasma as conservative treatment in orthopaedics: a systematic review and meta-analysis. Blood Transfusion, 16 (6), 502-513. (Level 2 evidence)

Johal, H., Khan, M., Yung, S.P., Dhillin, M.S., Fu, F.H., Bedi, A., & Bhandari, M. (2019). Impact of platelet-rich plasma use on pain in orthopaedic surgery: a systematic review and meta-analysis. Sports Health, 11 (4), 355-366. Abstract retrieved September 23, 2019 from PubMed database.

Kuang, M., Han, C., Ma, J., Li, F., Zhao, J., Fu, L., & Ma, X. (2016). The efficacy of intraoperative autologous platelet gel in total knee arthroplasty: a meta-analysis. International Journal of Surgery, 36 (pt A), 56-65. Abstract retrieved November 10, 2016 from PubMed database.

Ling, Y. & Wang, S. (2018). Effects of platelet-rich plasma in the treatment of plantar fasciitis: a meta-analysis of randomized controlled trials. Medicine, 97 (37), e12110. Abstract retrieved October 3, 2018 from PubMed database.

Lopez-Jornet, P., Sanchez Perez, A., Mendes, A., & Tobias, A. (2016). Medication-related osteonecrosis of the jaw: is autologous platelet concentrate application effective for prevention and treatment? A systematic review. Journal Craniomaxillofacial Surgery, 44 (8), 1067-1072. Abstract retrieved November 11, 2016 from PubMed database.

National Institute for Health and Clinical Excellence (NICE). (2013, January). Autologous blood injection for plantar fasciitis. Retrieved May 28, 2013 from http://www.nice.org.uk/guidance/.

National Institute for Health and Clinical Excellence (NICE). (2014, May). Platelet-rich plasma injections for knee osteoarthritis. Retrieved September 23, 2019 from http://www.nice.org.uk/guidance/. 

National Institute for Health and Clinical Excellence (NICE). (2013, January). Autologous blood injection for tendinopathy. Retrieved November 11, 2016 from http://www.nice.org.uk/guidance/. 

Suthar, M. Gupta, S., Bukhari, S., & Ponemone, V. (2017). Treatment of chronic non-healing ulcers using autologous platelet rich plasma: a case series. Journal of Biomedical Science, 24 (16). (Level 4 evidence)

Winifred S. Hayes, Inc. Medical Technology Directory. (2017, December; last update search November 2018). Platelet-rich plasma for treatment of lateral epicondylitis: a review of reviews.  Retrieved September 23, 2019 from www.Hayesinc.com/subscribers. (48 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2017, December; last update search March 2019). Platelet-rich plasma for treatment of ligament injuries and tendinopathies of the knee:  a review of reviews.  Retrieved September 23, 2019 from www.Hayesinc.com/subscribers. (41 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2017, November; last update search November 2018). Platelet-rich plasma for knee osteoarthritis: a review of reviews.  Retrieved September 23, 2019 from www.Hayesinc.com/subscribers. (48 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2018, March; last update search March 2019). Platelet-rich plasma for treatment of conditions of the Achilles tendon and plantar fascia.  Retrieved September 23, 2019 from www.Hayesinc.com/subscribers. (52 articles and/or guidelines reviewed)

Winifred S. Hayes, Inc. Medical Technology Directory. (2018, May; last update search June 2019). Platelet-rich plasma for rotator cuff repairs, tendinopathies, and related conditions: a review of reviews. Retrieved September 23, 2019 from www.Hayesinc.com/subscribers. (72 articles and/or guidelines reviewed)

ORIGINAL EFFECTIVE DATE:  1/14/2012

MOST RECENT REVIEW DATE:  11/14/2019

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