Mechanisms of platelet-rich plasma in promoting articular cartilage repair and advances in its adjunctive use in arthroscopy

doi:10.3877/cma.j.issn.1674-134X.2026.03.011

Abstract

Abstract:

Articular cartilage has limited capacity for self-repair, making cartilage regeneration a persistent challenge in orthopaedics. Platelet-rich plasma (PRP), derived from autologous blood and rich in growth factors, is simple to prepare and well tolerated, and has become an active area of cartilage repair research. PRP improves the repair microenvironment and supports cartilage regeneration by regulating chondrocyte apoptosis and autophagy, easing inflammation, and balancing angiogenesis. As an adjunct to arthroscopic surgery, it can be delivered by intraoperative or postoperative injection or via biomaterial scaffolds, helping to improve repair quality, relieve pain, and restore joint function. Its clinical use is still limited by unsettled questions over injection protocols, preparation standardization, and individualized treatment. This review outlined the mechanisms by which PRP promotes cartilage repair, examines its use alongside arthroscopic surgery and the supporting evidence, weighs current controversies, and considers its combination with stem cells, exosomes, and tissue engineering, aiming to inform cartilage repair in clinical practice.

Key words: Platelet-rich plasma, Arthroscopy, Cartilage, Regeneration, Osteoarthritis

Deyu Wang, Fumin Xue, Wei Wei, Xuefeng Guan. Mechanisms of platelet-rich plasma in promoting articular cartilage repair and advances in its adjunctive use in arthroscopy[J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(03): 344-352.

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References 102

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生长因子	关节软骨修复中的生物学功能	参考文献
PDGF	促进间充质干细胞与成骨细胞增殖，调节胶原蛋白合成，促进血管生成	Giusti等^［17］
TGF-β1，β2	促进软骨细胞增殖分化，增强基质金属蛋白酶抑制蛋白表达，抑制IL-1β对软骨细胞的干扰，阻止软骨细胞凋亡，促进血管生成	Xie等^［11］和Zhai等^［18］
VEGF	促进血管生成，增加微血管通透性，增强内皮细胞增殖	Apte^［19］
FGF	加速间充质干细胞向软骨细胞转化，促进血管形成，增加胶原蛋白分泌	Chen等^［20］和Jia等^［21］
IGF	调节成骨细胞和软骨细胞增殖分化，促进蛋白聚糖与胶原蛋白合成	Everts等^［22］
CTGF	促进血小板粘附、白细胞迁移和血管生成，调节胶原合成	Ornetti等^［23］
EGF	调节细胞增殖与凋亡，促进成纤维细胞迁移及上皮形成	Ai等^［24］

生长因子	关节软骨修复中的生物学功能	参考文献
PDGF	促进间充质干细胞与成骨细胞增殖，调节胶原蛋白合成，促进血管生成	Giusti等^［17］
TGF-β1，β2	促进软骨细胞增殖分化，增强基质金属蛋白酶抑制蛋白表达，抑制IL-1β对软骨细胞的干扰，阻止软骨细胞凋亡，促进血管生成	Xie等^［11］和Zhai等^［18］
VEGF	促进血管生成，增加微血管通透性，增强内皮细胞增殖	Apte^［19］
FGF	加速间充质干细胞向软骨细胞转化，促进血管形成，增加胶原蛋白分泌	Chen等^［20］和Jia等^［21］
IGF	调节成骨细胞和软骨细胞增殖分化，促进蛋白聚糖与胶原蛋白合成	Everts等^［22］
CTGF	促进血小板粘附、白细胞迁移和血管生成，调节胶原合成	Ornetti等^［23］
EGF	调节细胞增殖与凋亡，促进成纤维细胞迁移及上皮形成	Ai等^［24］

作者	年份	患者数（例）	部位	手术方式	软骨情况	干预方式	应用方案	疗效
Luo等^［63］	2022	57	髋关节	MF	Outerbridge Ⅳ级	PRP微粉化软骨+同种异体移植物	直接注射至缺损区	Tegner评分显著改善，术后1年总体生存率超过90%
丁晨等^［64］	2023	80	膝关节	AD	Kellgren-Lawrence分级Ⅰ～Ⅲ	PRP	注射1次，5 ml /次	调节炎性因子和骨代谢，促进修复
Wang等^［65］	2022	28	膝关节	MF	孤立全层软骨缺损	PRP和FG覆盖	注射1次，4 ml/次	有效修复缺损，缓解疼痛，改善功能
Krakowski等^［66］	2020	29	膝关节	MF	Ⅲ或Ⅳ级	PRP	直接注射至缺损区	显著改善WOMAC评分
朱艳艳等^［67］	2024	92	踝关节	MF	HeppleⅠ～Ⅲ期	体外冲击波联合PRP	注射4次，间隔7 d	减轻疼痛，改善功能
刘核达等^［68］	2024	60	踝关节	MF	HeppleⅤ期	PRP	注射3次，5 ml /次，间隔7 d	VAS、AOFAS改善
徐涛等^［69］	2024	24	踝关节	带骨膜髂骨移植	HeppleⅤ期	PRP凝胶	直接注射至缺损区	VAS、AOFAS改善
Fu等^［70］	2022	355	踝关节	MF	MRI病灶＜150 mm²	PRP	1次，3～5 ml /次	显著减缓影像学和功能性退化
张志伟等^［71］	2022	38	踝关节	OAT	HeppleⅤ期	PRP	注射1次，5 ml /次	减轻疼痛，改善功能
杨金杰^［72］	2020	43	踝关节	MF	损伤面积＜1.5 cm²	PRP	注射4次，2.5 ml /次，间隔7 d	减轻疼痛，改善功能
任弘^［73］	2021	100	踝关节	AD+MF	单侧距骨软骨损伤	PRP	注射3次，3 ml /次，间隔10 d	改善功能，减轻疼痛

作者	年份	患者数（例）	部位	手术方式	软骨情况	干预方式	应用方案	疗效
Luo等^［63］	2022	57	髋关节	MF	Outerbridge Ⅳ级	PRP微粉化软骨+同种异体移植物	直接注射至缺损区	Tegner评分显著改善，术后1年总体生存率超过90%
丁晨等^［64］	2023	80	膝关节	AD	Kellgren-Lawrence分级Ⅰ～Ⅲ	PRP	注射1次，5 ml /次	调节炎性因子和骨代谢，促进修复
Wang等^［65］	2022	28	膝关节	MF	孤立全层软骨缺损	PRP和FG覆盖	注射1次，4 ml/次	有效修复缺损，缓解疼痛，改善功能
Krakowski等^［66］	2020	29	膝关节	MF	Ⅲ或Ⅳ级	PRP	直接注射至缺损区	显著改善WOMAC评分
朱艳艳等^［67］	2024	92	踝关节	MF	HeppleⅠ～Ⅲ期	体外冲击波联合PRP	注射4次，间隔7 d	减轻疼痛，改善功能
刘核达等^［68］	2024	60	踝关节	MF	HeppleⅤ期	PRP	注射3次，5 ml /次，间隔7 d	VAS、AOFAS改善
徐涛等^［69］	2024	24	踝关节	带骨膜髂骨移植	HeppleⅤ期	PRP凝胶	直接注射至缺损区	VAS、AOFAS改善
Fu等^［70］	2022	355	踝关节	MF	MRI病灶＜150 mm²	PRP	1次，3～5 ml /次	显著减缓影像学和功能性退化
张志伟等^［71］	2022	38	踝关节	OAT	HeppleⅤ期	PRP	注射1次，5 ml /次	减轻疼痛，改善功能
杨金杰^［72］	2020	43	踝关节	MF	损伤面积＜1.5 cm²	PRP	注射4次，2.5 ml /次，间隔7 d	减轻疼痛，改善功能
任弘^［73］	2021	100	踝关节	AD+MF	单侧距骨软骨损伤	PRP	注射3次，3 ml /次，间隔10 d	改善功能，减轻疼痛

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[2]	Yutong Ji, Yuehui Zhou, Yangwenxiang Wei, Zhenqiu Chen, Haibin Wang, Chi Zhou. Mechanistic study on synovial macrophage-derived hepcidin inducing ferroptosis in chondrocytes [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(03): 322-333.
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[4]	Joint Surgery Group of the Orthopedic Society of the Chinese Medical Association. Expert consensus on the construction of autologous bone tissue banks [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(02): 141-150.
[5]	Rui Lin, Wenzhao Chen, Jiaying Liu, Xiangyu Long. Study on efficacy and mechanism of Taohong Siwu decoction in treatment of knee osteoarthritis [J]. Chinese Journal of Joint Surgery(Electronic Edition), 2026, 20(02): 206-214.
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[14]	Maosheng Wang, Qingyuan Kang, Wentao Xiao, Haidong Wang, Ping Yuan, Keshi Zhang, Tianming Mao, Zhenpeng Guan. Role of rs1426371 in the comorbidity of knee osteoarthritis and atherosclerosis: genetic and metabolomic insights [J]. Chinese Journal of Clinicians(Electronic Edition), 2026, 20(04): 256-264.
[15]	Fujun Wang, Xuan Wang, Jingxian Zhang. Genicular Artery Embolization: Recent Advances in Managing Knee Osteoarthritis Pain [J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2026, 14(02): 141-149.

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