What is Platelet Rich Plasma (PRP)?

Blood is made up of liquid and solids.  The liquid part called plasma is made of water, salts, and protein.  Over half of your blood is plasma.  The solid part of your blood contains red blood cells (RBC), white blood cells (WBC) and platelets.  RBCs deliver oxygen from your lungs to the tissues and organs throughout the body.  WBCs help to fight off infections and are part of your immune system.  Platelets are small colorless cell fragments which play a crucial role in tissue repair and regeneration.  Platelets are formed in the bone marrow and freely pass through the blood stream.  When an injury occurs, platelets become activated and they start to gather at the injury site.  Here they form a clot and release beneficial proteins called growth factors.  The growth factors send signals to recruit other healing cells to the area and start the healing process.

What is PRP Therapy?

Platelet rich plasma (PRP) therapy utilizes platelets taken from your own blood to repair or rebuild damaged tendons or cartilage.  The platelets are taken from your body with a routine blood draw, and the blood is separated with a centrifuge into its various components, to concentrate the platelets.  The platelets are then injected into the affected area to increase the growth factors in the injured site, and promote and accelerate the healing of the damaged tissue.

How Does a Platelet Rich Plasma (PRP) Injection Help Treat Tendon Injuries?

Tendons connect muscles to bones and help move and stabilize joints.  Once injured, tendons and ligaments do not heal easily because they naturally have a poor blood supply.  Platelet rich plasma injections are performed to optimize healing in various parts of the body.  The platelets are a component of our blood that contains a very large amount of healing factors and growth factors.  When there is an injury to the body, the injured area recruits platelets to the injury site to help repair the injury.  Platelets are vital for tissue regeneration because they contain hundreds of proteins called growth factors.  The rational for platelet rich plasma (PRP) injections for tendon type injuries is to harness the potential of the platelets and maximize their concentrations in the injured area to allow their healing factors to work more effectively and stimulate the healing process.

How Does a Platelet Rich Plasma (PRP) Injection Help Treat Osteoarthritis?

In a joint, the shiny slippery soft tissue that covers the bones on both sides of the joint is referred to as articular cartilage. This is because the cartilage covers bones’ surfaces where they articulate, or meet to form the joint. Articular cartilage has two primary purposes:

  • Smooth movement. Extremely slippery, articular cartilage allows bones to glide over each other as a joint flexes and straightens.
  • Shock absorption. Articular cartilage acts as a shock absorber, cushioning bones against impacting each other during a weight-bearing activity, such as walking or jogging.

Cartilage Damage

Despite its flexibility and strength, cartilage can be damaged. Problems can arise due to:

When cartilage is damaged, the bones may rub and grind against one another at the joint, causing friction.  Also, loss of the cartilage cap may lead to increased pressure on the underlying bone resulting in increased pain.

Does damaged cartilage ever heal?
Because it does not contain blood vessels, cartilage does not heal itself well. When cartilage has become thinned or damaged, a limited amount of new cartilage may be produced, but the new cartilage cells will grow in irregular, bumpy patterns. The result is that the bones may rub and grind against one another at the joint and this can be a source of pain.

Gradual onset of stiffness, pain, and swelling in the joint can be a sign of osteoarthritis.

While not all studies support the use of PRP to treat osteoarthritis, experts who have reviewed the existing body of research believe the evidence is largely encouraging and merits further investigation.

Recent studies have shown significant decreased pain and increased motion and function in joints injected with PRP for up to one year post injection. It is felt that this is possibly due to the concentrated healing elements and growth factors delivered into the joint and their potential anti-inflammatory ability.  It is also hoped that PRP may delay the progression of osteoarthritis.

Advantages of PRP Therapy

PRP is an autologous treatment, meaning the therapeutic agent comes from the patient’s own body.

Other than the risk of a blood draw and routine injection, there are no real negative side effects.

It does not have the side effects of cortisone shots, anti-inflammatory medications, or surgery.

It can be repeated with no long term consequences to the joint or soft tissue site injected.

PRP can be used in conjunction with other arthritis treatments such as physical therapy, exercise, weight loss, and activity modification.

What Does the Procedure Entail?

The procedure is done in a normal physician’s office setting.  A routine blood draw is done to obtain 15 to 30 cc of your blood.  The blood is then spun in a centrifuge to separate the blood into its various components and to concentrate the platelets in the plasma.  The platelets are then drawn into a second syringe.  The injured area is prepared by sterilizing the skin and injecting a local anesthetic into the skin to minimize the discomfort.  The platelets are then injected into the treatment area.  The whole process will take approximately 30 minutes.

What Can I Expect After My Injection?

Initially, the procedure may cause some localized discomfort and swelling which may last up to one week due to local irritation from the needle stick and stimulation of the inflammatory process which may last for up to one week.  The injected area should be treated with ice, elevation, and reduced activity for the first week after the injection.  Avoid NSAIDs such as aspirin or ibuprofen for two weeks after the injection since they can inhibit platelet activity.  A gradual return to activities of daily living is then suggested and a return to more strenuous activities will be discussed with your doctor as your symptoms improve.

 

For further information please go to the AAOS website and the OrthoInfo page regarding PRP https://orthoinfo.aaos.org/en/treatment/platelet-rich-plasma-prp/