Platelet Rich Plasma

A new procedure that is gaining popularity across the world in the treatment of tendinopathies and arthropathies is platelet rich plasma administration. This procedure is analogous to autologous blood injections, but involves delivery of the concentrated platelet rich plasma, which is rich in growth factors.

Blood platelets are responsible for bringing white blood cells to the injured area to clean up the remains of dead and injured cells. Most importantly to this discussion, blood platelets release growth factors that are directly responsible for tissue regeneration. These substances are called cytokines and include platelet derived growth factor, epithelial growth factor, and other important growth factors.

PRP has been used for years in surgical centers around the US and abroad to improve the success of bone grafting (especially in dental surgery) and also by cosmetic surgeons for speeding healing time and decreasing the risk of infection after surgery. Only in the last few years have doctors and surgeons been experimenting with injecting PRP for the treatment of chronic pain. Tennis elbow, plantar fasciitis, Achilles tendonitis/tendonosis, rotator cuff tears, meniscal tears, osteoarthritis and chronic low back and neck pain are all being treated with the injection of PRP with the goal of regenerating degenerated connective tissue with reports of success.

A PRP treatment looks like this: a patient's blood is drawn and placed into a special collection kit. Using the person's own blood eliminates the risk of transmission of any blood-borne disease. This kit is placed in a centrifuge for 15 minutes and the platelets and plasma are separated from the red and white blood cells. Two thirds of the plasma is removed and discarded and the remaining plasma is mixed with the platelets. This higher than normal concentration of platelets is what gives us platelet rich plasma. The PRP is drawn into a syringe. The area to be treated is injected with a local anesthetic and after waiting five minutes for the anesthetic to take effect, the PRP is injected.

The injection technique is identical to prolotherapy/regenerative injection therapy, only the solution injected is different. Same instrument, different sheet music. People generally report two days of being sore and then usually pain relief occurs within the first week and continues to improve over a period of months. To date, my experience is that one PRP treatment is the therapeutic equivalent of three or four prolotherapy/regenerative injection therapy treatments using dextrose. One of the attractive aspects of this treatment is the use of a person's own blood to eliminate the risk of the transmission of disease. The same lab that has developed the preparation kit for production of PRP has also developed a method to collect a person's own cells which eliminates the need for embryonic, umbilical or placental cells. This procedure is much more invasive as it requires a bone marrow biopsy and it is quite expensive compared to PRP which is safe, easy and inexpensive.

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4. After Care:

5. Re-evaluate in 4-6 weeks

1.Safety Considerations:

 Absolute contraindications

Relative contraindications

Post PRP Instructions
Articles on Platelet Rich Plasma:
Treatment of Tendon and Muscle Using Platelet-Rich Plasma by
Allan Mishra M.D., James Woodall M.D. and Amy Viera PA-C

How can one platelet injection after tendon injury lead to a stronger tendon after 4 weeks? by Olena Virchenko and Per Aspenberg

Clinical Updates in Platelet Gel: Sports Medicine by Michael A. Scarpone D.O.

Non-Surgical Repair of Patellar Tendonitis with Autologous Platelet Concentrate Using Ultrasound Guidance:Two Case Reports by Henry Stiene M.D.

Autologous Blood Injection for the Treatment of Chronic Recurrent Temporomandibular Joint Dislocation by Vladimir Machon M.D., D.M.D., Shelly Abramowicz D.M.D., M.P.H., Jan Paska M.D. and M. Franklin Dolwick D.M.D., Ph.D.

Treatment of Chronic Elbos Tendinosis with Buffered Platelet-Rich Plasma by Allan Mishra M.D. and Terri Pavelko P.A.C., P.T.