During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of injuries.
Many famous athletes — Tiger Woods, tennis star Rafael Nadal, and several others — have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.
Even though PRP has received extensive publicity, there are still lingering questions about it, such as:
- What exactly is platelet-rich plasma?
- How does it work?
- What conditions are being treated with PRP?
- Is PRP treatment effective?
WHAT IS PLATELET-RICH PLASMA (PRP)?
Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.
PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.
To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. Then the increased concentration of platelets is combined with the remaining blood.
HOW DOES PRP WORK?
Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.
To speed healing, the injury site is treated with the PRP preparation. This can be done in one of two ways:
- PRP can be carefully injected into the injured area. For example, in Achilles tendonitis, a condition commonly seen in runners and tennis players, the heel cord can become swollen, inflamed, and painful. A mixture of PRP and local anesthetic can be injected directly into this inflamed tissue. Afterwards, the pain at the area of injection may actually increase for the first week or two, and it may be several weeks before the patient feels a beneficial effect.
- PRP may also be used to improve healing after surgery for some injuries. For example, an athlete with a completely torn heel cord may require surgery to repair the tendon. Healing of the torn tendon can possibly be improved by treating the injured area with PRP during surgery. This is done by preparing the PRP in a special way that allows it to be stitched into torn tissues.
WHAT ARE THE ADVANTAGES OF PRP?
- If you look at the basic science studies, PRP supports the growth of articular cartilage cells (chondrocytes) in the laboratory by nourishing chondrocytes and growing extracellular matrix. In other words, it grows the constituents of cartilage around it, within a culture medium. This ability is known as being ‘chondrogenic’. PRP has also been shown to be chondrogenic by making stem cells, whether they are derived from bone marrow or from fat, go down a more cartilage-producing lineage than a bone-producing lineage, which could be very promising area of research in the future.
- What has been problematic is the translation of those basic science studies to clinical practice. There are numerous case reports in which PRP has been used for treating cartilage injury or osteoarthritis, and they have reported good results. Systematic reviews of the available evidence have shown that the use of PRP has led to improved clinical outcomes in patients with osteoarthritis. Furthermore, the use of PRP has also been shown to have a beneficial effect for the treatment of osteochondral defects. A recent systematic review found that compared to the use of HA and a placebo saline injection, that the use of PRP was associated with some beneficial effects in terms of clinical outcomes in patients with mild to moderate knee OA.
WHAT ARE THE DISADVANTAGES OF PRP?
Major impedance to the use of PRP is its extremely high cost, which is typically not covered by your insurance company. Therefore, it is important to discuss the use, risks and benefits of PRP with your healthcare provider prior to making a significant financial investment.
CONDITIONS COMMONLY TREATED WITH PRP INJECTIONS
- Rotator Cuff Tendinitis, Bursitis, Biceps Tendinitis, Arthritis
- DeQuervain’s Tenosynovitis, Arthritis, Wrist/Finger tendinitis, ligament tears
- Lateral and Medial epicondylitis (Tennis & Golfer’s elbow)
- IIliotibial Band Tendinitis (ITB Syndrome), Psoas Tendinitis and bursitis, Trochanteric Bursitis, Hip labrum tears, Piriformis Syndrome, Osteoarthritis
- Patellar Tendinitis, Chondromalacia Patella, partially torn or strained ligaments of knee (ACL/LCL/MCL), Meniscus Tears, Osteoarthritis, Pes Bursitis
- Achilles Tendinitis, Peroneal Tendinitis, Osteoarthritis, Recurrent ankle sprains, Ankle tendinitis