Platelet Rich Plasma Injections
WHAT IS IT
Platelet Rich Plasma or at is affectionately called “Blood Spinning” is the newest procedure in the Sports Medicine Physicians arsenal. While this procedure has been used in the dental field for many years it has only become available as an office procedure in Sports Medicine over the last couple of years.
The procedure initially involves taking a specific amount of blood. The blood is then placed in a centrifuge and spun down into layers. The platelet poor plasma is withdrawn and we are left with a small portion of platelet rich plasma. We then have a concentration of platelets which is 3-5 times the concentration in normal blood. This small concentration is then injected into the injured area.
There are three main types of cells in blood. Red blood cells carry oxygen to tissues. White blood cells fight infection. The third type of cells are platelets. While we mostly think about palettes function in stopping bleeding they play a very important role in healing damaged tissue. Platelets are full of intrinsic growth factor (more than 30) and other morphologic hormones that stimulate healing of damaged tissue. All of these factors are important in the role of cell replication, angiogenesis, fibroblasts, neovascularization and collagen production. All these activities contribute to the repair of tendon, skeletal muscle and bone.
The concept if the PRP injection is to stimulate the body to potentiate a healing response. PRP has been shown to recruit reparative cells. PRP is injected in an inactivated form and once injected into the body it is activated by collagen within connective tissue. The PRP then releases its growth factors and cytokines. These in turn stimulate local stem cells. The PRP also inhibits excess inflammation which causes scar tissue. The end result is healing of tissue to it’s as normal as possible physiologic state.
PRP can be used both in acute and chronic conditions. In the acute phase it can get an athlete back on to the playing field faster with better and quicker healing of tissues. In chronic conditions it is used to jump start the body to heal tissue that the body has failed to heal and the healing response has stalled?
PRP is can be utilized on any muscle or tendon but the following are the most common parts injected.
- Shoulder-rotator cuff
- Elbow-Lateral or Medial Epicondylitis-Tennis or golfers elbow
- Groin-Gluteal muscles-adductor tendon
- Knee-Patellar Tendon-Jumpers knee
- Achilles Tendon-Tears-Chronic Inflammation
As PRP as an office procedure is fairly new the research on its effectiveness is just starting to appear. The difficulty is that there are several different types of methods to prepare the PRP and they all vary on their concentration of platelets and other components that are to be injected. That being said there are now several papers indicating a very promising response to treatment. Those of us in the fields who are most experienced have all seen (although not in all) excellent results.
A small amount of blood is withdrawn from your body (20-60 cc’s). This blood is mixed with an anti-coagulant and then placed in a special centrifuge and double spun. The platelet poor plasma is withdrawn leaving a small concentration of platelet rich plasma. This amount (3-10 cc’s) is injected into the injured tissue. This is almost always done under the control of ultrasound guided injection to ensure we are placing their PRP exactly into the injured tissue. This is usually followed by an injection of a prepared thrombin clot which acts liked a matrix to hold the PRP fluid in the injured area.
Unlike cortisone injection where you may have an immediate response from the anti-inflammatory effect the PRP injection is stimulation a proper healing response within the bodies tissues. The healing response works over 6-8 weeks so it may be 8-12 weeks before you feel the total effects of the injection. Depending on the area injected and the severity and chronicity of the problem one or two subsequent injections may be necessary. A good program of physical rehabilitation is required to full rehabilitate the body back to full functional capacity.
As this is a medical procedure generally not covered under extended health insurance plans unless you have a discretionary component of your plan to use as you desire.