One of the most exciting advancements in regenerative medicine is the use of platelet-rich plasma (PRP) for treating orthopedic injuries and chronic pain conditions. PRP injections use the patient’s own blood that is spun to concentrate one’s own growth factors and platelet cells, to then regenerate tissue and structures.
What is PRP?
PRP is a volume of plasma that has a concentrated platelet count. Plasma is the clear solution that makes up around 60% of your total blood volume. While 90% water, plasma also contains hormones, proteins, clotting factors (platelets), immunoglobulins, and minerals.
There are four categories of PRP that are differentiated based on their leukocyte and fibrin content. These are leukocyte-rich PRP, leukocyte reduced PRP, leukocyte platelet-rich fibrin, and pure platelet-rich fibrin. The utility of PRP is based on the presence of certain growth factors that have been proven useful for tissue repair. After the platelets have been collected, they are activated by the addition of thrombin and calcium chloride, which causes the release of growth factors from alpha granules.
The growth factors and cytokines that are present in PRP are platelet-derived growth factor, transforming growth factor beta, fibroblast growth factor, vascular endothelial growth factor, epidermal growth factor, Interleukin 8, keratinocyte growth factor, and connective tissue growth factor.
PRP is taken from the patient’s own blood via an arm vein. This procedure is much like a typical blood draw. After obtained, the blood is placed in a centrifuge machine, which spins it around rapidly (a process called centrifugation). The plasma and platelets are separated from the rest of the blood components.
Benefits of PRP
PRP therapy has many benefits. These include:
Ability to facilitate tissue repair
Has growth factors that draw cells from the body to regenerate damaged tissue
Has a high success rate
Is a minimally invasive procedure
Conditions that typically benefit from PRP
PRP is being used to relieve many chronic and acute pain conditions, as well as dermatologic conditions. These include:
Lateral epicondylitis (tennis elbow)
Medial epicondylitis (golfer’s elbow)
Knee ligament injuries
Patellar tendinitis (runner’s knee)
For skin rejuvenation
Before and After PRP Therapy
You will meet with the Chicago pain management specialist to discuss your symptoms, condition, and medical history. Be sure you tell the doctor about medicines you take, surgeries you had, and all illnesses and disorders. The doctor may order some tests to evaluate your problem.
Once you decide on the PRP therapy protocol, the doctor reviews risks and benefits and has you sign a consent form. After the procedure, you will have a period of exacerbation (temporary increased pain). This is due to the body’s inflammatory process. After 2-4 weeks, you will begin to show improvement. PRP therapy results are noted at 3-9 months after the injections.
The PRP Procedure
Platelet-rich plasma comes from blood. The nurse will draw around 60 milliliters of your blood. The tubes of blood are placed in a laboratory centrifuge and spun into three layers. This process is called blood fractionation. The middle layer of the solution is the platelet-rich plasma. The red blood cells, white blood cells, and other blood components are discarded. The doctor will clean the injection site with an antiseptic, and use an anesthetic to numb the skin and deeper tissues. Depending on where the PRP is to be placed, a needle is guided into the area possibly using fluoroscopy (real-time x-ray) or ultrasound.
PRP Efficacy and Success
There are many clinical studies regarding the effectiveness of PRP. The National Football League (NFL), the Major League Baseball Association, and the National Basketball Association (NBA) all have determined that PRP is a reasonable treatment and does not represent a performance enhancing drug. In a randomized controlled trial, PRP was used for chronic tennis elbow. Of the 230 patients in the study, 76% reported success at 12 weeks in the PRP group. The control group received a steroidal injection, which was not as effective. In addition, PRP had an 85% efficacy rate at the 2-year follow-up visit.
In a systematic review of many studies involving PRP in the treatment of symptomatic knee osteoarthritis, researchers found the therapy worked well. With over 600 patients involved, the International Knee Documentation Committee scores favored PRP over hyaluronic acid in the treatment of knee arthritis. The researchers concluded that intra-articular PRP injections had beneficial effects in mild-moderate knee arthritis at the 6-month follow-up.
A 2010 review published in the Yale Journal of Biology and Medicine examined PRP as an efficacious treatment for the healing of wounds, particularly chronic diabetic foot ulceration. This treatment is especially promising due to the high safety margins as a result of PRP’s autologous nature.
Khoshbin A, Leroux T, Wasserstein D, et al. (2013). The efficacy of platelet-rich plasma in the treatment of symptomatic knee osteoarthritis: a systematic review with quantitative synthesis. Arthroscopy, 29(12), 2037-2048.
Mishra AK, Skrepnik NV, Edwards SG, et al. (2014). Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med, 42(2), 463-471.