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PLATELET RICH PLASMA

What is Platelet Rich Plasma (PRP)?

Platelet rich plasma (PRP) is a general term for new technologies that are focused on enhancing the healing response after injury of different tissue types. To understand PRP’s mechanism of action and possible applications, it is important to be familiar with the general healing response. General healing follows a pathway that begins with inflammation lasting days, continues with cellular and matrix proliferation for weeks, is followed by tissue formation and maturation for months, and ultimately, finishes with tissue remodeling, which takes years. PRP treatment contain high concentrations of platelets that, once activated, undergo degranulation to release growth factors with healing properties. They also contain plasma and other growth factors implicated in wound healing, in addition to thrombin, which has inherent biological and adhesive properties.

What Growth Factors are important in healing:

Factor Name Origin Effects
IGF-1 Insulin-like growth factor Activated platelets Stimulates osteoblast proliferation & differentiation
EGF Epidermal growth factor Activated platelets Stimulates epidermal cell proliferation & differentiation angiogenesis
VEGF Vascular endothelial growth factor Leukocytes Angiogenesis, osteoblast chemoattractant
PDGF platelet-derived growth factor Activated platelets Mitogenesis of mesenchymal stem cells (MSCs)
TGF- Transforming growth factor-beta Activated platelets Stimulation of DNA synthesis

 

When injury occurs, blood immediately rushes to the site and comes in contact with damaged collagen. This indicates the start of the healing process. Blood contact with collagen stimulates platelets within the blood to degranulate and release GFs such as PDGF, VEGF, and fibroblast growth factor (FGF), resulting in hematoma or clot formation. PDGF activates the appearance of neutrophils and machrophages within the first hour of injury to start clearing the site and start the production of type III collagen.  After 7-10 days, type I collagen replaces the type III collagen, and healing proceeds to completion, normally within 21-28 days post-injury. Platelet concentrate products may help the normal healing process by concentrating GFs all at once in one location.

How is PRP treatment done?

The basic mechanism for preparing PRP treatment involves withdrawal of the patient’s blood in the office, followed by centrifugation to obtain a concentration of platelets and cytokines well above the serum baseline. The selected part of the prepared concentrate (plasma) is then injected into the region where it is required.  This may be intralesional (as in the muscle), intra-articular (as in ACL reconstruction), or surrounding the involved tissue bed (e.g., within the Achilles tendon sheath after rupture repair). The entire treatment, from blood draw, to solution preparation, to injection, takes 30-40 minutes.  Before PRP injections are given the skin and underlying tissue is first anesthetized to minimize the discomfort.

How often are injections given?

After the initial treatment, a follow up visit is scheduled 4-6 weeks later to check on healing progress. Some patients respond very well to just one treatment. However, typically 2-3 treatments are necessary. Injections are given every 4-6 weeks on average

When Can I Expect to See Improvement?

On average, most patients start to see signs of improvement anywhere from 4-8 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.

Are There Risks With PRP?

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 Injection uses your own blood, you cannot be allergic to it.

What are some applications of PRP in sports medicine?

PRP systems have shown good results in various medical fields, from implantology to the treatment of vascular ulcers. Sports medicine patients want a rapid return to their pre-injury level of function , and PRP may have certain applications that will speed recovery in cases of tendon, ligament, muscle, and cartilage disorders.

PRP Applications Examples
Chronic tendinosis Tennis elbow
Tendinopathy Chronic rotator cuff tendinopathy, jumper’s knee
Acute tendon injury Achilles tendon rupture, SLAP lesions
Osteoarthritis Osteochondral defects
Musle injury Hamstrings tear
Osteochrondritis Osteochondritisdissecans lesions

Evidence for the benefits of PRP

Platelet Rich Plasma (PRP) is not a new an experimental technique. It has been widely studied since the early 1980’s and the first publication on it’s benefits for muscle healing was published in 1986. Since then there have been many in-vitro clinical studies demonstrating it’s benefit in enhancing the healing process in numerous areas of the body:

What Does PRP Treatment Cost?

At Mediworks,  the cost of PRP treatment is based on the level of complexity involved in treating a given area(s).  Prices range from $400 to $800 per treatment.

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