What is Platelet-Rich Plasma (PRP) Therapy?
Platelet-Rich Plasma (PRP) is a revolutionary treatment for chronic sports and musculoskeletal injuries. It has continued and expanded the revolutionary thinking of prolotherapists throughout the last half of the 20th century: that the body has the ability to heal itself when directed correctly. Professional and recreational athletes, along with laypersons experiencing degenerative pain conditions credit PRP treatment for enabling them to follow their passions. PRP is much less invasive than traditional surgeries for the same conditions, with much less downtime or time away from work.
Platelets are pieces of cells called megakaryocytes. They are released in the blood in large numbers and are generally associated with helping to form clots when you’re bleeding. The same functions of platelets that facilitate healing of tissue from traumatic injuries also encourages healing of degenerative tissue when a PRP mixture is introduced to the right location with the right type of procedures under precise guidance. For optimal healing, different locations in the body require different concentrations of platelets for optimal healing. Moreover, red blood cells (RBCs) in the injection will inhibit healing and create much more pain.
First, we prepare a patient by increasing their platelet concentration with an exercise protocol. In the office, blood is drawn from the patient’s artery under ultrasound guidance to ensure maximal safety. OrthoCure is unique in this preparation—early in the clinic’s history we completed studies that showed a 10-30% increase in the number of platelets in arterial blood compared to blood from a vein. The blood is then placed in a centrifuge that separates the RBCs, and the remaining platelets and plasma are then highly concentrated. The red blood cells are discarded, and the resulting platelet concentrate is used for treatment.
A very unique feature at OrthoCure Clinic is that we measure the number of platelets in the volume of fluid (plasma) that we inject. We can vary this number based on location, the number of structures to treat, and the type of tissue to optimize healing. We believe this is a critical step, otherwise, there is no way to know how many platelets are being “dosed” in your injections.
The entire treatment, from the blood draw to solution preparation, to injection, takes 2-4 hours in the clinic, also a unique experience at OrthoCure Clinic. To prepare you, complete an arterial blood draw, process your sample, measure your sample, create a final concentration for the injection and to do the procedures under both ultrasound and fluoroscopy takes time, patience and precision. We treat every procedure as if it was being done in an operating room.
Not All PRP Is The Same!
Currently, there are over half a dozen companies making and selling commercial PRP preparation systems, of course with each company claiming that their PRP is the best! PRP products can vary widely in terms of platelet concentrations, the presence or absence of red blood cells (RBCs), the presence/absence of white blood cells (WBCs), and the volume of PRP created.
Some PRP is not much better than whole blood or platelet poor plasma, with very low platelet concentrations. Much of the commercial PRP is rich in RBCs, which have been shown to kill synovial cells inside a joint. Many PRP products contain high amounts of inflammatory WBCs, contributing to increased post-injection pain.
When OrthoCure Clinic was founded, we spent an extensive amount of time and money to optimize our PRP preparations. We invested in a cell counter and flow cytometry to prove the exact concentrations of platelets as well as the presence of small circulating stem cells. We vary the concentration of our platelets from 1.5 billion per cc to 10 billion per cc, depending on the structure in which we are injecting (this is 2-10 times more platelets than commercial systems will create). There are less than 1% RBCs and we remove the white blood cells (WBCs) that are currently believed to be inflammatory in a way that’s not helpful for healing. Then, we took an additional step. We invested in a centrifuge that has the horsepower to concentrate a protein called Alpha-2-Macroglobulin (A2M—a molecule that has been associated with cartilage repair) and had an outside lab validate that the protein was present in our samples.
We take all these steps to ensure that you receive a PRP product that is the absolute highest quality, purity, and effectiveness currently available.
PRP treatment works best for chronic ligament and tendon sprains/strains that have failed other conservative treatment, including:
- Neck injuries such as whiplash, arthritis & chronic instability
- Rotator cuff injuries, including partial-thickness & full-thickness tears (up to 1 cm)
- Shoulder pain & instability
- Tennis & golfer’s elbow
- Wrist tendon & fibrocartilage (TFCC) injuries
- Hamstring & hip tendon degeneration
- Pubic symphysis injuries & instability (Athletic pubalgia)
- Knee sprains & instability, including partially torn ACLs
- Patellofemoral syndrome & patellar tendinosis
- Ankle sprains, tendon degeneration & instability
- Achilles tendinosis & plantar fasciitis
- Knee, hip, and the
- Other chronic tendon and ligament problems
PRP can be very helpful for many cases of osteoarthritis (the “wear & tear” kind). PRP can help stimulate a “smoothing over” of the roughened and arthritic cartilage, reducing the pain and disability of arthritis. This includes:
- Knee arthritis
- Hip joint arthritis
- Shoulder arthritis
- And other joint arthritis
Platelet-Rich-Plasma Therapy FAQs
The level of discomfort of the treatment depends in part on the area being treated. For example, injections into a joint often are minimally uncomfortable and in some cases painless. Injections into tendons and the capsules of joints tend to be more uncomfortable. There is usually moderate pain for the next few days. In cases where large numbers of injections will be completed, Dr. Hanson will perform a regional nerve block to reduce pain during and after the injection whenever possible.
We provide oral sedation, aromatherapy and oxygen to help with pain and anxiety during an injection. In addition, we have a master Reiki practitioner who is available to perform energy healing before or after a procedure.
On average, most patients start to see signs of improvement anywhere from 2-12 weeks after treatment. This can be less overall pain, an ability to do more activity before pain sets in, and/or faster recovery from pain.
Anytime a needle is placed anywhere in the body, even getting blood drawn, there is a risk of infection, bleeding, and nerve damage. However, these are very rare. Other complications, though rare, can occur depending on the area being treated, and will be discussed by your doctor before starting treatment. Because PRP uses your own blood, you cannot be allergic to it.
Studies suggest an improvement of 80-85%, though some arthritic joints, namely the hip, do not respond as well. Some patients experience complete relief of their pain. In the case of tendon and ligament injuries the results are generally permanent. In the case of joint arthritis, how long the treatment lasts depends partly on the severity of the condition. Mild arthritis may not need another round of treatments. More advanced arthritis, on the other hand, typically requires a repeat course of treatment, usually in 1-3 years.
This is a frequently asked question. In the case of mild arthritis, PRP treatment may halt the development of further arthritic decay. However, in advanced arthritis, as noted above the goal of treatment is to reduce pain and improve function. In some cases the arthritis is so severe that PRP is not a viable option. In severe or advanced osteoarthritis PRP treatments may help delay the eventual need for a joint replacement, but it is rarely a treatment that eliminates the need for it. Some patients are not surgical candidates because of other medical conditions. Other patients simply do not want joint replacement surgery under any circumstance. In these cases PRP may be a viable treatment option, but it is not a permanent solution in these specific situations–treatments will need to be repeated periodically.