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Platelet Rich Plasma (PRP)

If you suffer from osteoarthritis of the thumbs, knees and hips, rotator cuff and labral tears in the shoulders, tendonitis, or a variety of sports injuries, this groundbreaking treatment can help you.

What is PRP?

In a nutshell, Platelet Rich Plasma (or PRP) is a procedure that separates the platelets from a patient’s blood and reintroduces them into the injured or arthritic joint. Platelets have special regenerative properties and also attract the assistance of stem cells. This delivery of a high concentration of platelets essentially kick starts and intensifies the body’s natural healing and regenerative processes.

PRP has been proven to reduce pain, improve range of motion, repair tissue, and help return patients to their normal lives. What’s more, PRP can also be an effective preventative measure against surgery by repairing injured tissues before the damage becomes irreversible.

Indications

PRP is an autologous concentrate of platelets and growth factors within a relatively small volume of blood plasma designed to promote healing and regeneration. This treatment modality is effective for use in soft tissue and musculoskeletal injuries, such as tendonitis and ligament tears. PRP is particularly effective in treating injured areas of the body where blood supply is scant or diminished, making it difficult for the body to deliver endogenous platelets and growth factors to heal itself. Injections of PRP to these areas can essentially circumvent a decrease in vascular access and force healing in the following conditions:

Prepared Platelet Rich Plasma PRP  Lateral Epicondylitis – Tennis Elbow
 Medial Epicondylitis – Golfer’s Elbow
 Knee Pain secondary to OA and soft tissue injuries
 Hip Pain secondary to OA and labral tears
 Achilles Tendonitis
 Patellar Tendonitis – Jumper’s Knee
 Plantar Fasciitis
 OA – Thumbs
 Rotator Cuff and Labral Tears of the Shoulder
 Degenerative Disc Disease
 Peri-operatively with bones grafts, maxillofascial surgery dental implants
 Preoperatively and intraoperatively for total and partial joint replacements
 Soft tissue injuries such as meniscal, ligament and muscle tears (limited evidence – animal models only)

What Are The Benefits?

PRP can be used to treat the following conditions:

  • Regeneration of cartilage in osteoarthritis of the thumbs, knees and hips
  • Non-surgical repair for rotator cuff and labral tears in the shoulders
  • Sports injuries, including tennis elbow & golfer’s elbow
  • Ligament & meniscal tears
  • Tendonitis

Published studies on PRP have shown:

  • Restoration and smoothing of rough cartilage
  • Improved range of motion
  • Resolution of pain in osteoarthritis of the hips, knees and shoulders
  • Restoration and smoothing of rough cartilage

More Details

fractionated-blood-300x279Platelet Rich Plasma is a groundbreaking treatment option for treating painful orthopedic injuries and conditions that have traditionally required surgery to correct. In cases where surgery is unavoidable, PRP can be used to enhance surgical repair.

In the procedure, platelets from the patient’s blood are concentrated, harvested, and re-injected into the injured area or arthritic joint. Once introduced, the platelets release substances known as growth factors that lead to improved natural tissue healing. Platelets initiate repair and attract the assistance of stem cells. This is known regenerative injection therapy.

The injected platelets release the growth factors and facilitate the process of regeneration and remodeling of the damaged area, thereby strengthening and expediting the healing process.

The therapeutic effect of PRP is thought to be facilitated through the release of a variety of growth factors:[i]

  • PLT-derived growth factor AB (PDGF-AB)
  • Transforming growth factor β1 (TGF β1)
  • Fibroblast growth factor (FGF)
  • Vascular endothelial growth factor (VEGF)
  • Connective tissue growth factor (CTGF)
  • Epithelial growth factor (EGF)
  • Insulin-like growth factor 1&2 (ILGF)
  • Keratinocyte growth factor (KGF)

In addition to these growth factors, PRP contains the chemokine Interleukin 8 (IL-8) which is believed to promote angiogenesis (the formation of new blood vessels) and improve blood flow.

These factors are located within the PLT’s themselves and are released upon activation, or in the case of PRP injection – into the injured body part to facilitate a focal and highly localized healing process.

PRP also contains the three proteins in blood known to act as cell adhesion molecules for osteoconduction as well as serve as a matrix for bone, connective tissue and epithelial migration:[1]

  • Fibrin
  • Fibronectin
  • Vitronectin

[i] Civinni R, Nistri L, Martini C, et al. Growth factors in the treatment of early osteoarthritis. Clin Cases Miner Bone Metab. 2013;10:26-9.”

How Does It Work?
Making Platelet Rich Plasma PRP

Ainsworth Institute uses the most advanced instrumentation available

If you’ve ever donated blood, or had blood drawn for a lab test, you’ve already experienced the extent of what’s involved with PRP therapy. The doctor places your blood in a centrifuge which spins it at high speeds for 10-20 minutes in order to separate out the platelets. The platelets are extracted by syringe and injected into the problem area.

It’s that simple.

How Many Treatments Will I Need?

Most patients require two treatments. Patients with severe problems may require more.

When Will I Feel Better?

The positive effects of the injection can occur within a week. This usually happens with torn tendons/ligaments and bursitis. Most patients, though, begin to see results in approximately six weeks, and gradually improve as the body’s healing process is strengthened by the therapy.

Is PRP Right for Me?

If traditional treatments and therapies have not provided you relief, PRP may be an option. It’s less invasive, less aggressive, and less expensive than surgery. The procedure involves minimal to no scarring, and alleviates further degeneration of tissues that could otherwise require a surgical intervention.

Contact the Ainsworth Institute to set up an initial evaluation to find out if you are a candidate for PRP.

The Caption of Procedure Two

Platelet-Rich Plasma (PRP) is most concisely defined as a volume of plasma that contains a concentrate of platelets (PLT) above that of baseline blood levels.

Procedure - Patient Details


PRprp1-225x300OCEDURE

Your physician will first draw some of your blood.  As mentioned above, this is much the same procedure you encounter when donating blood or getting lab work done.  The blood is then transferred to a specialized container that has been pre-prepared with certain chemicals that aid in the separation process.  The container is placed into a centrifuge and the sample is spun at high speed for 10 to 20 minutes.  When this procedure is completed, the centrifuge will have separated your blood into two distinct reservoirs within the container.

  • One reservoir will contain plasma and the separated, concentrated platelets at the bottom (the platelet rich plasma).
  • The other reservoir will contain the rest of the blood which will be discarded.

The platelet “rich” portion is extracted into a syringe and prepared for injection into the problem area.

 

RESTRICTIONS – BEFORE THE PROCEDURE

  • Do not take Non-Steroidal Anti-Inflammatory Medications (NSIAD’s) for 1-week prior to the procedure – this includes aspirin, ibuprofen, Naproxen, etc.
  • Do Not Take Steroids of any kind for 10-days prior to the procedure – this includes prednisone, Medrol dose packs, cortisone and cortisone injections.

 

RESTRICTIONS – AFTER THE PROCEDURE

  • Do Not Take Non-Steroidal Anti-Inflammatory Medications (NSIAD’s) and/or Steroids for 1-month after the procedure.

 

GETTING BACK TO NORMAL

PRP_ExerciseFor the first 48 hours after the procedure we recommend you carry on as normal, but with no strenuous activity or exercise.  After 10-12 days, you can start light exercise, but return to stressful activity only after six weeks. 

**Returning to stressful activity before six weeks will result in incomplete healing of the treated tissue.

Risk Factors

As with any medical or surgical procedure, there is always a risk of complication. The most common complaints people have after a PRP injection is of pain an irritation. The procedure may initially cause some localized soreness and discomfort which can be treated with nothing stronger than Extra-Strength Tylenol. Ice and heat may also be applied to the area as needed.

Often, the body purposely creates inflammation around the injection site in order to lure additional assistance from growth factors and inflammatory markers. In these cases, discomfort can persist in the patient for up to 10 days.

Other potential risks include infection from drawing blood, or the process of the injection itself.

It’s important to remember…

While PRP has been proven effective, it is still technically experimental. Patients often respond well to more traditional avenues of therapy and treatment. The Ainsworth Institute recommends that PRP be pursued only after conservative treatments have been exhausted (physical therapy, anti-inflammatory medications, and rest).

As with anything considered experimental, results may vary and not every patient will have success.

Evidence of Performance

PRP is a safe and accepted treatment.  Patient-derived PRP has been used for over 30 years as an aid in recovery following certain surgical, orthopedic and dental procedures.  There are thousands of research articles published on the safety of PRP. 

Evidence
  •  
  •    Level I
  •    Level II-1
  •    Level II-2
  •    Level II-3
  • LOCATION
  • Evidence obtained from at least one properly designed randomized controlled trial.
  • Evidence obtained from well-designed controlled trials without randomization.
  • Evidence obtained from well-designed cohort or case-control analytic studies, preferably from more than one center or research group.
  • Evidence obtained from multiple time series designs with or without the intervention.
  • INDICATIONS
  • · Lateral Epicondylitis (Tennis Elbow)[i],[ii],[iii]
    · OA – Hips4
    · OA – Knees[iv]
    · Maxillofacial Surgery1
    · Shoulder pain – including acromioclavicular joint and rotator cuff injuries[v]
  • · Patellar Tendonosis (Jumper’s Knee) [vi]
    · ACL and MCL repairs (animal studies)
  • · Achilles Tendonitis[vii]
    · Plantar Fasciitis [viii]
    · Medial Epicondylitis (Golfer’s Elbow)
  • · Degenerative Disc Disease[ix]

In a 2008 study, Mishra reported on 140 patients with tennis and golf elbow who failed to respond to conservative treatments (physical therapy, medications, etc) and were treated with PRP.  All the patients in this study were being considered for surgery.  Patient were given a single treatment of PRP and were followed for 3 years.  The PRP treated patients reported a 93% reduction in pain at 38 months post-injection.[1] Other studies have attempted to explore PRP and establish it as an effective treatment for regenerating cartilage in osteoarthritis.[2]

 

 

The Ainsworth Institute is Here to Help

If you are suffering from chronic pain and would like to see if you may be a candidate for this revolutionary new treatment, contact the Ainsworth Institute of Pain Management today.  Schedule an appointment with one of our Board Certified Physicians to learn if PRP is right for you.

References

[1] Marx RE, Platelet-Rich Plasma – Evidence to support its use. J Oral Maxillofac Surg. 2004;62:489-496.

[2] Foster TE, Puskas BL, Mandelbaum BR, et al. Platelet-rich plasma: From basic science to clinical applications. Am J Sports Med. 2009;37:2259-72.

[3] Kevy SV, Jacobson MS. Preparation of growth factors enriched autologous platelet gel. Proceedings of the 27th Annual Meeting of Service Biomaterials, April 2001.

[4] Pourcho AM, Smith J, Wisniewski SJ, Sellon JL. Intraacrticlar platelet-rich plasma injection in the treatment of knee osteoarthritis: Review and recommendations. Am J Phys Med Rehabil. 2014;93:S108-21.

[5] Al-Ajlouni J, Awidi A, Samara O, et al. Safety and efficacy of autologous intra-articular platelet lysates in early and intermediate knee osteoarthritis in humans: a prospective open-label study. Clin J Sport Med. 2014 – Publication Pending

[6] Patel S, Dhillon MS, Aggarwal S, et al. Treatment with platelet-rich plasma is more effective than placebo for knee osteoarthritis: a prospective, double-blind, randomized trial. Am J Sports Med. 2013;41:356-64.

[7] Kon E, Mandelbaum B, Buda R, et al. Platelet-rich plasma versus hyaluronic acid viscosupplementation as treatments for cartilage pathology: from early degeneration to osteoarthritis. Arthoscopy. 2011;27:1490-501.

[8] Sun Y, Feng Y, Zhang CQ, et al. The regenerative effect of platelet-rich plasma on healing in large osteochondral defects. Int Orthop. 2010;34:589-97.

[9] Kevy SV, Jacobson MS. Comparison of methods for point of care preparation of autologous platelet gel. J Extra Corpor Technol. 2004;36:28-35.

[10] Civinni R, Nistri L, Martini C, et al. Growth factors in the treatment of early osteoarthritis. Clin Cases Miner Bone Metab. 2013;10:26-9.

[11] Narouze S. Atlas of ultrasound-guided procedures in interventional pain management. 1st Edition. Springer, New York. 2011.

[12] Anitua E. The use of plasma rich growth factors (PRGF) in oral surgery. Pract Proced Aesthet Dent. 2001;13:487.

[13] Landesberg R, Roy M, Sleichman RS. Quantification of growth factor levels using a simplified method of platelet rich plasma gel preparation. J Oral Maxillofac Surg 2000;58:297-300.

[14] Landesberg, R, Burke A, Pinksy D, et al. Activation of platelet-rich plasma using thrombin agonist receptor peptide. J Oral Maxillofac Surg 2005; 63:529-35.

[15] Lippi G, Salvagno GL, Montagnana M, et al. Influence of the needle bore size on platelet count and routine coagulation testing. Blood Coagul Fibrinolysis 2006; 17:557-61.

[16] Anitua E. Plasma rich in growth factors: preliminary results of use in the preparation of sites for implants. Int J Oral Maxillofac Implants. 1999; 14:529–535.

[17] Eby EW. Platelet-rich plasma: Harvesting with a single-spin centrifuge. J Oral Implantol. 2002; 28:297–301.

[18] Marx RE, Carlson ER, Eichstaedt RM, Schimmele SR, Strauss JE, Georgeff KR. Platelet-rich plasma: Growth factor enhancement for bone grafts. Oral Surg Oral Med Oral Pathol Oral Radiol. 1998; 85:638–646

[19] Tetschke E, Rudolf M, Lohmann, CH, et al. Autologous proliferative therapies in recalcitrant lateral epicondylitis. Am J Phys Rehabil. 2014 – Pending Publication

[20] Thanasas C, Papadimitriou G, Charalambidis C, et al. Platelet-rich plasma versus autologous whole blood for the treatment of chronic lateral elbow epicondylitis: A randomized controlled clinical trial. Am J Sports Med. 2011;39:2130-4.

[21] Gosens T, Peerbooms JC, van Laar W, den Oudsten BL. Ongoing positive effect of platelet-rich plasma versus corticosteroid injection in lateral epicondylitis: A double-blind randomized controlled trial with 2-year follow-up. Am J Sports Med. 2011;39:1200-8.

[22] Nguyen RT, Borg-Stein J, McInnis K. Applications of platelet-rich plasma in musculoskeletal and sports medicine: an evidence-based approach. PM R 2011; 3:226-50.

[23] Filardo G, Kon E, Della Villa Set al. M. Use of platelet-rich plasma for the treatment of refractory jumper’s knee. Int Orthop 2010; 34:909-915

[24] Diehl JW. Platelet-rich plasma therapy in chronic Achilles tendonopathy. Techniques in Foot & Ankle Surgery 2011; 10:2-6.

[25] Tinsley BA, Ferreira JV, Dukas AG, et al. Platelet-rich plasma nonoperative injection therapy – a review of indications and evidence. Oper Tech Sports Med 2012; 20:192-200.

[26] Kepler CK, Anderson DG, Tannoury C, Ponnapan RK. Intervertebral disc degeneration and emerging biologic treatments. J Am Acad Orthop Surg 2011; 19:534-53.

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