Platelet-rich plasma Injections
Platelet-rich plasma (PRP) injections offer the clinician a new and exciting method of treating many injuries which until this point were the realm of the orthopedic surgeon in the operating room. Many famous athletes 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. PRP injections are now becoming mainstream treatments for a variety of musculoskeletal conditions, and they are now becoming an essential therapeutic treatment options.
Common Questions & Answers about Platelet-rich Plasma
1. What is Platelet-rich Plasma?
- 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. When the platelets are concentrated the growth factors are also concentrated, which can be 5 to 10 times greater (or richer) than usual. The use of concentrated growth factors is considered by many to be an exciting and new cutting edge therapy that can stimulate tissue repair, and regenerate weakened torn or damaged ligaments, ligaments and joints. They recruit stem cells and have direct effects on many different types of tissue. PRP contains a number of different kinds of cells including:
2. Neutrophils, which represents 40% to 75% of the circulating leukocytes.
3. Monocyte-macrophages, which represent 2% to 10% of the circulating leukocytes.
4. Fibroblasts, which produce collagen, reticular fibers, glycosaminoglycans, and glycoproteins – these compounds are very important in the production of tendons and articular cartilage.
5. Endothelial cells – these regulate permeability barriers, blood flow and vascular reactivity, act as vasodilators and constrictors, and regulate inflammation and immunity.
6. Keratinocytes, which are stratified squamous epithelial cells. Their primary function is to act as a barrier.
7. Research suggests that there is also a primitive mesenchymal-type stem cell found in PRP.
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.
- 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 actually be stitched into torn tissues.
- Weakened torn or damaged ligaments, tendons, muscle tears, menisci or labrums are the most common soft tissue structures that are treated. PRP has also been effective in treating arthritis.
- Knees: meniscus, ACL, MCL LCL, arthritis, knee cap instability
- Shoulder: Rotator Cuff Tears, labrum tears, tenositis
- Hip: labrum, tenositis, Bursitis
- Low Back: Facet joints, arthritis, Sacro-Iliac dysfunction
- Ankle/Foot: Achilles dysfunction, tendonitis, arthritis, ankle sprains
- Elbow: Tennis elbow (later epicondylitis, golfers elbow (medial epicondylitis)
- Wrist/Hand finger/joint tendinitis, ligament tears, arthritis, carpel tunnel
- The patient’s blood is collected and then spun in a centrifuge specifically designed to concentrate platelets. Second a local anesthetic is provided to the affected region. The PRP is then injected into the affected area.
- Patients typically tolerate the procedure well although post-injection soreness is sometime experienced.
- Growth Factors are released from large quantities of activated platelets at the site of injury. This leads to a reaction that initiates a healing cascade. Growth factors stimulate promote stimulate healing of weakened, torn or damaged soft tissue such as tendons, ligaments, meniscus or labrum.
- PRP actually heals the injured region. Unlike pharmaceutical medications like ibuprofen or cortisone, which just take the pain away but do not heal the injury.
- The risks associated with it are minimal: There may be increased pain at the injection site, but the incidence of other problems — infection, tissue damage, nerve injuries — appears to be no different from that associated with cortisone injections.
- This is ultimately decided on a case-by-case basis. Dr. Patel will use the MRI or Ultrasound results to determine the number of injections. Typically, Dr. Patel will suggest between two to four treatments depending on the degree of injury and how long the injury has been there.
- Typically about every 6 weeks if indicated.
- For the first 48 hours, swelling and mild discomfort are typical in the injected area. Therefore, all patients are provided with pain medicine after PRP. By day 3, these symptoms will begin to substantially resolve.
- How quickly you can return to your normal activities depends on the condition and body part being treated.
• Injections in the elbow or shoulder are placed in a sling for 48 hours to 1 week or more and then as needed for comfort.
• For the ankle (Achilles tendon, peroneal tendon, plantar fascia), you will be required to wear a walking boot for up to two weeks or more. (If the injection is on the right side, you will not be able to drive with the boot on.)
• If you have an injection in your knee for osteoarthritis, you only need to rest for 24 hours and then you can return to your normal activities.If the injection is in your patellar tendon or quadriceps tendon, your knee will be placed in a knee immobilizer for 1-2 days.
• All procedures, except for possibly knee osteoarthritis, will begin therapy 1 week after the injection.
- Most patients notice some element of improvement by 2-6 weeks after PRP treatment. Symptom improvement is slow and subtle as days and weeks pass, with usual report of original pain being lessened over time. Increased endurance and strength are typically reported.
- If the injection is in your right knee or ankle, you will not be allowed to drive home. If the injection is located in any other body part, you may drive yourself home after the injection.
- Yes, Dr. Patel will want to see you back in clinic to check your progress. You will be asked to make a follow up appointment 6 weeks following the injection.
- Do not take anti-inflammatory medication such as Advil, Aleve, Motrin, Ibuprofen, Mobic, Naproxen, Nabumetone, or Diclofenac for 7 days prior to the injection and 6 weeks after the last injection. Pain medication will be prescribed the day of the procedure to be taken as needed. A regular aspirin regimen (81mg/day) is ok. Tylenol/Acetaminophen is allowed.
- Yes, the physician will most likely prescribe physical therapy to help you regain your strength, mobility, and function. Typical physical therapy programs last approximately 12 weeks. Your insurance company usually covers physical therapy, but you should call your insurance company to confirm.
- Minimal side effects have been observed with treatment. Any stiffness or discomfort reported after PRP should resolve with time.
- PRP therapy is advised for patients with osteoarthritis in the hip, knee or shoulder or chronic tendonitis in the elbow or ankle. Typically the patient has failed conservative treatment options such as rest, medication, and physical therapy.
- • If you live near Newport, we recommend scheduling an appointment for a consultation with Dr. Patel, so that she can look at your radiology films (x-rays) and examine you to determine if you are a good candidate or not.
• If you live more than 3 hours away, please work with your local health care professional to send us the following:1. Recent x-ray and/or MRI (no more than a few months old) 2. Medical records (pertaining to your injury)
• Send your images and records to Dr. Patel for review - please include your contact information.
• We will contact you back about our decision with in 7-10 business days.
Start Today by Contacting Dr. Patel to Schedule Your Private Consultation to see what PRP can do for You!