Platelet-Rich Plasma Concentrate to Augment Bone Fusion

The community-based foot and ankle surgeon often treats patients with significant comorbidities and local tissue pathology, which makes osseous procedures, and in particular arthrodeses, substantially more difficult. A complete understanding of orthobiologic augmentation products available to the surgeon is crucial in assisting the surgeon to successfully apply these technologies and help to ensure improved surgical outcomes. PRP offers a relatively cost-efficient method of delivering directly to the surgical site a number of key growth factors known to be instrumental in the bone-healing cascade. In the United States, many community-based practitioners often find their "hands tied" when it comes to the use of expensive biologic materials in both the hospital and surgical center settings. The body of evidence on the use of PAP in the foot and ankle literature is small, but compelling, with a greater amount of positive data existing in the dental and spine literature. It appears that relative proportions of PLTs in PAP may be critical to the successful application of PAP. Despite the limited number of foot and ankle PAP studies, it is the authors' opinion that PAP provides a safe and cost-effective method of delivering important growth factors to promote osseous healing in patients at moderate risk for delayed and nonunion. Nothing eliminates the need for appropriate surgical indications and meticulous surgical technique; PRP is, strictly speaking, an orthobiologic adjuvant that may be used to assist with bone healing.