PRP

Platelet Rich Plasma Therapy

Platelet Rich Plasma (PRP) therapy is an emerging form of treatment offering encouraging signs in accelerating healing of musculoskeletal injuries in patients without subjecting them to significant risk. The philosophy of PRP therapy is to merge cutting edge technology with the body’s natural ability to heal itself.

PRP can be made in many different ways, from expensive commercial systems, to simple manual methods that can be performed by a doctor in their rooms. To date, there has been no “optimal” way to produce PRP, and depending on the injury being treated, different ways are likely to have different effects.  Put simply, about 50ml of blood is taken from the patient. It is placed into a centrifuge to separate the blood into 3 layers. The bottom layer is red blood cells, the top layer, platelet poor plasma and the middle layer, platelet rich plasma. The middle layer is collected and then activated using calcium to release growth factors from the platelets. This platelet rich plasma is then injected into the injured area.

The growth factors found in platelets are many and varying and can have a positive effect in people with conditions like arthritis (1, 2, 3, 4) and tendinopathies or tendinitis (5,6, 7, 8). In the case of osteoarthritis, it is thought that PRP improves synovial fluid production (9), thus improving the “oil” within the joint.

Importantly, PRP therapy is safe. As the procedure only uses your own blood there is no risk of HIV, Hep B, Hep C or other blood borne infections. It has also been shown to have anti-bacterial activity against common skin organisms which are the major source of infection in joint injections (10).

It should be noted that PRP therapy is just single part of an optimal treatment protocol for tendinopathies and osteoarthritis. It is best combined with an individually designed gradual exercise program and correction of predisposing factors, and if necessary in the case of osteoarthritis, weight loss.

Multiple studies have been undertaken on PRP and include:

  • Osteoarthritis – Decrease in pain improved function over 12 months (1)
  • Osteoarthritis – Improved pain with comparison to Synvisc (2)
  • Osteoarthritis – Decrease in pain greater than Synvisc (3)
  • Cartilage defects – Improves pain and function (4)
  • Patella tendinopathy (Jumper’s Knee) – Decrease in pain (8)
  • Patella tendinopathy (Jumper’s Knee) – Decreased pain in with 3 injections of PRP (5)
  • Lateral epicondylitis (Tennis Elbow) greater decrease pain compared to cortisone (6)
  • Lateral Epicondylits (Tennis Elbow) greater decrease in pain at 12 months compared to Cortisone (7)
  • Plantar fasciitis – improved pain (11)
  • Achilles tendinopathy – No benefit with a single injection (12)

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1.        Kon E, Buda R, Filardo G, Di Martino A, Timoncini A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma: intra-articular knee injections produced favorable results on degenerative cartilage lesions. Knee Surg Sports Traumatol Arthrosc. 2010 Apr;18(4):472-9. Epub 2009 Oct 17

2.        Sánchez M, Anitua E, Azofra J, Aguirre JJ, Andia I. Intra-articular injection of an autologous preparation rich in growth factors for the treatment of knee OA: a retrospective cohort study.  Clin Exp Rheumatol. 2008 Sep-Oct;26(5):910-3.

3.       Baltzer AW, Moser C, Jansen SA, Krauspe R. Autologous conditioned serum (Orthokine) is an effective treatment for knee osteoarthritis. Osteoarthritis Cartilage. 2009 Feb;17(2):152-60. Epub 2008 Jul 31.

4.        Filardo G, Kon E, Buda R, Timoncini A, Di Martino A, Cenacchi A, Fornasari PM, Giannini S, Marcacci M. Platelet-rich plasma intra-articular knee injections for the treatment of degenerative cartilage lesions and osteoarthritis. Knee Surg Sports Traumatol Arthrosc. 2010 Aug 26. [Epub ahead of print]

5.        Filardo G, Kon E, Della Villa S, Vincentelli F, Fornasari PM, Marcacci M. Use of platelet-rich plasma for the treatment of refractory jumper’s knee. Int Orthop. 2009 Jul 31.

6.        Mishra A, Pavelko T. Treatment of chronic elbow tendinosis with buffered platelet-rich plasma. Am J Sports Med. 2006 Nov;34(11):1774-8. Epub 2006 May 30.

7.        Peerbooms JC, Sluimer J, Bruijn DJ, Gosens T. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial: platelet-rich plasma versus corticosteroid injection with a 1-year follow-up. Am J Sports Med. 2010 Feb;38(2):255-62.

8.        Kon E, Filardo G, Delcogliano M, Presti ML, Russo A, Bondi A, Di Martino A, Cenacchi A, Fornasari PM, Marcacci M. Platelet-rich plasma: new clinical application: a pilot study for treatment of jumper’s knee. Injury. 2009 Jun;40(6):598-603. Epub 2009 Apr 19.

9.       Anitua E, Sánchez M, Nurden AT, Zalduendo MM, de la Fuente M, Azofra J, Andía I. Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology (Oxford). 2007 Dec;46(12):1769-72.

10.   Bielecki TM, Gazdzik TS, Arendt J, Szczepanski T, Król W, Wielkoszynski T. Antibacterial effect of autologous platelet gel enriched with growth factors and other active substances: an in vitro study. J Bone Joint Surg Br. 2007 Mar;89(3):417-20.

11.   Barrett S, Erredge S. Growth factors for chronic plantar fascitis.Podiatry Today. 2004;17:37–42.

12.     de Vos RJ, Weir A, van Schie HT, Bierma-Zeinstra SM, Verhaar JA, Weinans H, Tol JL. Platelet-rich plasma injection for chronic Achilles tendinopathy: a randomized controlled trial. JAMA. 2010 Jan 13;303(2):144-9.

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