Type A

Platelet-Rich Plasma

PRP Therapy (Platelet-Rich Plasma)

Although PRP (Platelet-Rich Plasma) Therapy has been around since the mid-1990s many people are still unaware of this beneficial treatment.

Various fields of medicine, including dentistry, neurosurgery, wound healing, and orthopedics, have only just begun to scrape the surface of the long-term and ongoing benefits that can result from employing this valuable therapy.

What is it? A Quick Lesson on Blood
In a nutshell, a PRP injection delivers a high concentration of endogenous (your own “home-grown”) platelets to an area of injury.

To understand the therapeutic value of PRP injections, you need to have a basic understanding of the make-up of blood. Blood is composed of plasma, red blood cells, white blood cells, and platelets. It’s these platelets that are the injury’s “first-responders” and help revascularize an injured area, construct new tissue, and stop the bleeding.

Because platelets play a significant role in the healing of tissue, reintroducing a high concentration of platelets directly into the injured area may enhance the healing process.

The physiological effects include:

• Increase tissue regeneration (tendon, ligament, soft tissue)
• Decrease inflammation
• Decrease pain
• Increase collagen (base component of connective tissue)
• Increase bone density
• Increase angiogenesis (development of new blood cells)

In the world of high-stakes sports, many stars swear by it. Tiger Woods received PRP injections in his left knee following surgery, and L.A. Dodger’s pitcher, Takashi Saito was able to return to the mound for the 2008 playoffs as a result of this little-known therapy.

Studies have seconded these testimonials. A recent study published in the American Journal of Sports Medicine (2006) reviewed the effectiveness of PRP therapy in patients with chronic elbow pain. Fifteen patients were treated with PRP therapy. The results documented a 60% improvement at eight weeks, 81% at six months, and 93% at final follow-up (12-38 months). There were no side effects or complications reported.

The Trouble with Tendons
Tendon injuries often become chronic because of the poor blood supply to these areas. Athletes and active people tend to have these issues and sometimes a whole career or hobby can be ruined by this ongoing complication. A PRP injection allows a quick and focused action to the area of injury, which allows it to heal more effectively and rapidly.

The Procedure
A patient’s blood is drawn and placed in a centrifuge which separates the platelet-rich plasma from the rest of the blood. This plasma is then injected into the area of injury. It’s a quick procedure with little, if any, downtime. It’s also safe because the platelets are derived from the patient’s own blood, so there is no risk of rejection or reaction.

Not every patient is treated with PRP.
We do not treat every patient with PRP, most often, Dextrose Prolotherapy is used instead of PRP, because of the extra step in drawing your blood, the extra expense in purchasing the PRP kit, and the extra time it takes to prepare the platelets. The injections are exactly the same way, but the proliferant, or solution injected is different. For many years we have had great success in healing 1000’s of patients’ and having them avoid surgery with dextrose Prolotherapy.

Your decision to have PRP should be discussed with us to determine which type of Prolotherapy, (Dextrose, platelets, or another proliferant) is best for you.

Not every doctor is proficient in PRP Therapy
Platelet Rich Plasma Therapy has become very popular. Physicians who do not do traditional Prolotherapy are now offering PRP. Unfortunately, these untrained doctors are injecting the platelets in a way that is often painful, debilitating for weeks, and can leave hematomas (collections of clotted blood) in the area injected. We believe that PRP is best delivered by a physician already experienced and well versed in Prolotherapy.

Platelet alpha granules contain potent growth factors necessary to begin tissue repair and regeneration at the wound site. Concentrated autologous platelets contain large reservoirs of growth factors that have the potential to greatly accelerate the normal healing process, naturally. The use of concentrated growth factors is considered by many to be a “new frontier” of clinical therapy

Excerpts in this article from Harvest Technologies Corp

1. Marx, R.E. , et al,“Platelet-Rich Plasma Growth Factor Enhancement for Bone Grafts”, Oral Surg Oral Med Oral Patrhol, 1998;85:638-646.

2. Antonaides, H.N., et al,“Human Platelet-Derived Growth Factor: Structure and Functions”, Federation Proceedings, 1983;42:2630-2634.

3. Pierce, G.F., et al,“PDGF-BB,TGF-ß1 and Basic FGF in Dermal Wound Healing: Neovessel and Matrix Formation and Cessation Repair”, Am J Pathology, 1992;140:1375-1388.


Overview

PRP is an autologous blood therapy that stimulates your body’s natural healing process through the injection of its own growth factors into injured areas. Research and clinical data show that PRP injections are extremely safe, with minimal risk for any adverse reaction or complication. Because PRP is produced from your own blood, there is no concern for rejection or disease transmission. There is a small risk of infection from any injection into the body, but this is rare. Some research suggests that PRP may have an anti-bacterial property which protects against possible infection.

Your body naturally recruits platelets and white blood cells from the blood to initiate a healing response. Under normal conditions, platelets store numerous growth factors which are released in response to signals from the injured tissue. Special PRP devices concentrate platelets from whole blood. When the PRP is injected into the damaged tissue growth factor release is enhanced so that natural healing is accelerated. Desired results include by enhancing the body’s natural healing capacity, and a more rapid, more efficient, more thorough restoration of tissue to a healthy state.

History

PRP was initially developed in the 1970s. It enjoyed increasing use in hospital and outpatient surgical settings in the 1980’s and began to be utilized in physician offices for musculoskeletal procedures in the 1990’s. Technological advances have enabled the administration of PRP to become more popular among musculoskeletal physicians (physiatrists and orthopedists) since 2000. Much of the original PRP use centered around orthopedic surgical procedures, such as spinal fusions and joint replacements, however PRP has also enjoyed extensive use among maxillofacial and plastic surgeons and dermatologists.

Pathophysiology

Rotator Cuff

After an injury, the repair response of musculoskeletal tissues starts with the formation of a blood clot and degranulation of platelets, which releases growth factors and cytokines at the site. This microenvironment results activation of inflammatory cells and proliferation of local progenitor cells. In most cases, fibroblastic scar tissue is formed. In some settings, however, such as in a fracture callus, these conditions can also facilitate the formation of new bone tissue.

Transforming growth factor beta (TGF-b), platelet-derived growth factor (PDGF), insulin-like growth factor (IGF), vascular endothelial growth factors (VEGF), epidermal growth factor (EGF) and fibroblast growth factor-2 (FGF-2) are growth factors that can be found at injury sites during wound healing. In addition to soft tissue repair (muscle, tendon, ligament and supporting joint structures), PRP has been shown to enhance one or more phases of osteogenesis, early angiogenesis and revascularization.

Studies also recognize the possibility that the effect of the clot microenvironment or concentrates of PDFGs on fracture repair might be either positive or negative. The nature of this effect, like that of many graft materials, depends on the clinical setting, particularly the graft site’s local environment of cells in which PRP or associated factors are placed.

In summary, available data suggest that PRP is valuable in enhancing soft-tissue repair and in wound healing. The clinical role of PRP in bone repair remains controversial, however. PRP is not uniformly successful as an adjuvant to bone grafting procedures. PRP may promote or inhibit bone formation, depending on the setting in which it is used and the quality of the PRP.

Example musculoskeletal conditions and symptoms treated with PRP

Fibulo-Talo Ligament Strain

* Sports injuries

  • Joint pain associated with arthritis
  • Ligamentous strain
  • Tendinosis, Tendinopathy
  • Reflex muscle spasm
  • Recurrent swelling or fullness involving a joint or muscular region
  • Popping, clicking, grinding, or catching sensations with movement
  • Spinal pain (musculoskeletal; non-neurogenic in origin)
  • Distinct tender points and “jump signs” along the bone at tendon or ligament attachments
  • Sclerotomal numbness, tingling, aching, or burning, referred into an upper or lower extremity
  • Recurrent, referred headache, face pain, jaw pain, ear pain

Treatment

Platelet Injection

In most instances, PRP is not the first treatment employed. Other traditional interventions such as restorative therapies, medication, anesthetic injection and [Prolotherapy] are frequently employed first. Most musculoskeletal physicians will use Prolotherapy prior to PRP when considering regenerative treatment for muscle, tendon, ligament or supporting joint structures, however individual considerations exist. Examples where PRP might be utilized first include professional athletes that need rapid wound healing time, more severe cases and instances where multiple problems exist.

PRP is an effective alternative to invasive arthroscopic surgery, including those cases that have failed or that simply are not remedial to arthroscopy. When contraindications exist for joint replacement (obesity, age, medical co morbidity)PRP is a beneficial alternative as well.

The PRP process involves drawing blood, spinning it down to separate out growth factor rich platelets, then injecting the platelet rich plasma into the injured area. To make the injection more comfortable, local anesthetic (numbing medicine) or nerve blocks are performed first. To help ensure the accuracy of placement, Ultrasound guidance is employed (see [Diagnostic musculoskeletal ultrasound]).

Most patients don’t require anything more than acetaminophen for pain from the procedure. Often, following a PRP injection, an “achy” soreness is felt. This “soreness” is a positive sign that healing has been set in motion. The soreness can last for several days but gradually decreases as healing and tissue repair occurs. It is important that anti-inflammatory medications such as Ibuprofen, Aleve, and Aspirin be avoided following PRP treatments.

These medicines may block the effects of the PRP injection. While many patients find it best to rest the area for several days after PRP, as long as you are responsible you can resume normal activities following I treatment. You should avoid anything other than light activity however for at least several days after injection.

Depending on your response to treatment, one to three PRP injections may be required. Following the initial treatment, a follow-up visit will usually be scheduled within 2-3 weeks. At that time a decision may be made regarding the need for additional treatment. In general, chronic or severe injuries require more treatment than mild injuries. Restorative therapy including exercise or physical therapy may be prescribed as well.