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1 Introduction
2 Muscle Injury and Repair
3 Growth Factor Research
4 Application Techniques

Direct injection of synthetic Growth Factors and Cytokines can be useful but, because the life cycle of these substances is short, repeated injections may be required. This is uncomfortable and increases the risk of infection. Because of this drawback, new techniques have been sought to deliver these substances to the injury site.

Gene therapy is a method whereby the genetic material of Growth Factors and Cytokines are removed from the injured tissue, the genes are manipulated outside the body, packaged into a ‘vector' and re-injected into the target cells. This allows the continued production of these Growth Factors and Cytokines at the injury site.

The major concern about using the still developing gene therapy in sports injuries is safety. Whilst the risks of gene therapy may be acceptable for severe disorders such as cancer or cystic fibrosis, the risk of side effects may be unacceptably high in the treatment of sports induced soft tissue injury. The integration of vectors into the host may cause the gene to mutate. Abnormal regulation of cell growth, toxicity from chronic over production of the Growth Factor and Cytokines, and the threat of tumour formation are all theoretically possible, although no cases have as yet been reported. However, these side effects may not occur until years later.

Due to these potential risks, other techniques are being used to try and deliver increased Growth Factors and Cytokines to the injury site. One technique, evolved from Oral and Maxillofacial surgery, involves the laboratory production of 'Platelet Rich Plasma' (PRP) which is blood with a high concentration of Platelets (irregular shaped cells in the blood that form blood clots). Platelets are the source of one Growth Factor that is part of the healing process – Platelet Derived Growth Factor (PDGF).

Platelet Rich Plasma is derived by taking a sample of the patient's blood and subjecting it to a centrifugal force by spinning it very fast in a device called a centrifuge. The machine spins the blood at about 6000rpm, before being slowed to 2500rpm. This separates the constituent parts of the blood allowing the PRP to be 'harvested'.

Blood counts have shown that this method of preparation increases the number of platelets by 300% to 700%, leading to a 7 to 30 fold increase in Platelet Derived Growth Factor. This harvested Platelet Rich Plasma is then re-injected into the injury site in an attempt to optimise tissue healing.