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Platelet Rich Plasma Injection

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To date, one area where accelerated tissue healing has been demonstrated is wound healing with the use of platelet rich plasma. As it turns out, this substance is now being used to help accelerate the healing of conditions such as tendonitis, ligament strains, muscle strains, arthritis, synovitis (inflammation inside the joint), and cartilage defects.

Platelet rich plasma is employed as a matrix graft, often referred to as an autologous tissue graft. This platelet-rich plasma (PRP) matrix is defined as a “tissue graft incorporating autologous growth factors and/or autologous undifferentiated cells in a cellular matrix where design depends on the receptor site and tissue of regeneration.” (Crane D, Everts PAM. Practical Pain Management. 2008; January/February: 12- 26) 2008)

The reason this substance is so useful is that platelets, which are a constituent of normal blood, contain multiple growth factors that stimulate tissue growth. This is particularly true for collagen which is the main component of connective tissue such as tendons and cartilage. These factors include transforming growth factor-Β (TGF-B), fibroblast growth factor, platelet-derived growth factor, epidermal growth factor, connective tissue growth factor, and vascular endothelial growth factor.

These growth factors recruit undifferentiated cells to the site of injury and stimulate their growth. Another constituent of platelets, stromal cell derived factor I alpha causes newly recruited cells to adhere to the area.

PRP needs to be prepared in a way to ensure a maximal amount of platelets along with a high concentration of growth factors. Obviously, the more growth factors that can be delivered to the site of injury, the more likely tissue healing takes place.

This type of autologous tissue graft (ATG) is currently being used in musculoskeletal medicine for patients with pain and injury in joints, tendons, and ligaments.

Contrast this approach with the traditional approach which has been to use non-steroidal-anti-inflammatory drugs as well as steroid injections, which, while reducing inflammation, also impede the healing process.

ATG is often used in conjunction with percutaneous tenotomy where a patient undergoes a procedure where there is purposeful needle irritation of the affected area using ultrasound guidance after which PRP is then slowly injected into the site.

The use of diagnostic ultrasound has revolutionized the field of musculoskeletal medicine in allowing tissue healing procedures like tenotomy which often prevent the need for open surgical procedures with their attendant morbidity and mortality.

The average number of treatments required is two to three separated by four to eight week intervals.

The PRP is prepared by drawing 20 cc's of whole blood from the patient and then spinning the blood in a special centrifuge that layers out the platelets. This 20 cc's of whole blood generally yields about 2-10 cc's of platelet rich plasma.

Contraindications to the administration of PRP include platelet dysfunction, low platelet count, infection, anemia.

Prior to a PRP procedure, a patient needs to hold their non-steroidal anti-inflammatory drugs for at least 3-4 days. They may resume them one week after. Also, patients with rheumatoid arthritis should hold their methotrexate for at least one week before and one week after the procedure. Patients on biologic medicines may need to hold their medicines longer, particularly when it comes to adalimumab (Humira), and infliximab (Remicade) because of the long half life of these drugs.

Following the procedure, patients must rest the affected area to prevent leakage of the PRP from the site.

Pain at the injection site is common for a 1-2 day period following the procedure.

For more information on tenotomy and platelet rich plasma, call the Arthritis and Osteoporosis Center of Maryland at (301) 694-5800

Platelet Rich Plasma Injection

Platelet rich plasma (PRP) therapy is a cutting-edge non-surgical technique that is now available for use as an in-office procedure. Years ago, it was thought that platelets functioned solely to form blood clots -- or, more specifically, to bind to each other at the sight of bleeding in order to form a "plug" to stop the flow of blood. Recent research has shown, however, that the platelet has a far greater role in the healing process than initially thought. When platelets aggregate at the sight of an injury, they not only form the plug to stem the bleeding but they also release growth factors. These growth factors, also known as cytokines, aid in the healing of injured tissues.

PRP Therapy: The Process

PRP therapy requires only a small amount of normal blood from the patient (approximately 20 cc's). This blood sample is placed into a centrifuge in the office and is spun for approximately fifteen minutes. The final product is a highly concentrated platelet rich gel, which, when applied to injured tissue, accelerates the normal healing process.

On the day of the treatment, the patient is seated in the exam chair and blood is taken from his or her arm. Once the PRP gel is ready for implantation, the area being treated is injected with local anesthesia after which there is no further discomfort from the procedure.

To insure the accuracy of the placement of the platelet rich gel a diagnostic ultrasound is used. Then a needle attached to a syringe containing the gel is guided by the ultrasound into the areas of injury. After the procedure, a simple Band-Aid is applied. Because there is no surgical incision involved there is little or no post procedural pain.

The Science

When the PRP gel is applied to the area of injury, the platelets are activated to produce proteins capable of stimulating cellular growth, proliferation and cellular differentiation called growth factors. By concentrating the number of platelets found in normal blood by 10 times, the concentration of growth factors in the area is equally enhanced. This is significant in terms of the healing process because growth factors are responsible for attracting stem cells that will eventually become new tendon, bone or fascia.

The procedure is very safe. Since the blood is drawn and processed immediately in the same facility there is no chance of contamination or blood from another patient. Also since the injection consist of blood from the same patient begin treated there is no chance of allergy or drug reactions. Additionally, platelets have a natural antibiotic quality so there is very little chance of infection.

Use

In my practice, by far the most common ailment treated with PRP is the painful heel condition known as plantar fasciitis. However, I have also successfully treated tendonitis, partial tendon ruptures and inflammatory bone conditions.

PRP versus Cortisone Injections

When PRP is compared to cortisone injections for inflammatory conditions there are many striking differences. Cortisone injections result in immediate pain relief. PRP injections do not act as quickly. PRP procedures take longer to deliver results because the growth factors take time to grow the new tissue. However, the platelets release the growth factors that attract the stem cells and then produce repaired "new" tissue. The cortisone reduces the inflammation immediately but actually causes tissue weakening and damage.

So the choice between cortisone and PRP comes down to fast relieve with potential tissue damage or actual new and repaired tissue that takes longer to relieve pain. This new innovative and cutting-edge technique is just the beginning of the new branch of science known as "orthobiologics". The day is fast approaching when medical science will be able to create new parts to cure the ailments and injuries that plague our bodies. "Protein Rich Plasma" is one of the modalities that are currently available to help the body accelerate the healing process and create new, repaired, healthy tissue.

PRP in the news:

The following articles on PRP are sited for your further reading on this subject:

http://articles.latimes.com/2008/oct/03/sports/sp-dodfyi3

http://www.nytimes.com/2009/02/17/sports/17blood.html'_r=1&emc=eta1

http://www.sportsgeezer.com/sportsgeezer/2009/02/simple-blood-treatment-helps-heal-most-sports-injuries.html

Copyright (c) 2009 Bruce Lashley

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About Author

Both Nathan Wei & Bruce Lashley are contributors for EditorialToday. The above articles have been edited for relevancy and timeliness. All write-ups, reviews, tips and guides published by EditorialToday.com and its partners or affiliates are for informational purposes only. They should not be used for any legal or any other type of advice. We do not endorse any author, contributor, writer or article posted by our team.

Nathan Wei has sinced written about articles on various topics from Arthritis Pain, Health and Arthritis Signs. Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info:. Nathan Wei's top article generates over 550000 views. Bookmark Nathan Wei to your Favourites.

Bruce Lashley has sinced written about articles on various topics from Build Muscle, Fitness and Lose Weight. Bruce Lashley, DPMDr. Lashley is a podiatrist practicing in midtown Manhattan for the past 27 years. He specializes in the conservative and surgical management of the foot. He has been a participating sports enthusiast his entire life. As a health care pr. Bruce Lashley's top article generates over 18100 views. Bookmark Bruce Lashley to your Favourites.

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