PRPisPlatelet-Rich Plasmatherapy. Although an emerging technology and technique in sports medicine, it has been used since the mid-1990s in dental and oral surgery and to aid in soft tissue recovery following plastic surgery.

RP treatment recently gained widespread recognition in the sports world when Hines Ward and Troy Polamalu of the Pittsburgh Steelers received PRP therapy prior to winning Super Bowl XLIII. Other high profile athletes include Tiger Woods who received four treatments following knee surgery and pitchers Takashi Saito and Bartolo Colon -- both recent examples of PRP success in Major League Baseball.

PRP therapy, which takes approximately twenty minutes to complete, begins with collection of 30 milliliters of the patients blood. The blood sample is placed in a centrifuge to separate the platelet-rich plasma from the other components of whole blood. Doctors then inject the concentrated platelets into the site of the injury often using ultrasound guidance for accuracy. Platelets function as a natural reservoir for growth factors that are essential to repair injured tissues. The growth factors that the platelets secrete stimulate tissue recovery by increasing collagen production, enhancing tendon stem cell proliferation, and tenocyte-related gene and protein expression. These growth factors also stimulate blood flow and cause cartilage to become more firm and resilient. PRP activates tenocytes to proliferate quickly and produce collagen to repair injured tendons, ligaments, cartilage, and muscles.

You will feel a notable increase in pain in the days immediately following the injection. Pain intensity becomes less each day as functional mobility and general functional ability increase along with endurance and strength. You will notice gradual improvement 2-6 weeks after PRP therapy. Some patients report ongoing improvement 6-9 months after PRP therapy is administered. In some studies, Ultrasound and MRI images have shown definitive tissue repair has occurred after PRP therapy, supporting the proof of the healing process. By treating injured tissues before the damage progresses, surgical intervention may be avoided.

Injuries treated with PRP therapy include: rotator cuff, quadriceps, hamstring, Achilles tendon injuries and tennis elbow. Essentially any tendon or ligament injury except complete tears may be treated successfully with PRP. PRP therapy is exactly the treatment needed to reduce the downtime of the athlete while also reducing the chance for re-injury or perhaps the risk of a more serious injury that will result in surgical intervention or permanent disability.

Not necessarily. While many chronic conditions may respond to PRP therapy, obviating the need for a surgical procedure, it is impossible to predict which will respond and which will fail to do so. A chronic, incompletely healed condition is characterized by excessive scar tissue within the tendon/ligament. This may lead to impaired joint function or leave the tendon or ligament susceptible to re-injury or complete disruption. This inferior, or in some cases, aborted, healing process is due to poor blood supply to the injury site. Most tendons have a poor blood supply and often are the site of microscopic tears or chronic scarring. The body naturally has a difficult time healing these structures. PRP is thought to initiate a response that makes the chronic condition appear to be a new injury, and thus, provoke a new/renewed healing response. This new healing response is then augmented by the super-concentrated healing factors contained within the PRP. Therefore, with PRP therapy in combination with appropriate reconditioning, we may improve the chance of healing and diminish the opportunity for escalation of the injury. A positive result may lead to a decrease need for surgical intervention.

Unfortunately, there is no randomized, prospective, double-blind clinical trial that documents the efficacy of PRP treatment. For this reason, most insurance companies will not support (read: pay for or "cover") PRP treatment. Moreover a standard treatment regimen does not yet exist (i.e. Number of injections required, spacing between injections given in series, rehabilitation protocol during and after a series, etc); however, PRP is being used with regularity at the highest levels of sport and in the most highly compensated athletes in the world today. Claims of successful treatment are purely anecdotal; case reports abound of successful PRP treatment of almost any malady. Conditions that can be treated successfully with PRP therapy include the shoulder involving: rotator cuff tendinitis, impingement, bursitis, and bicipital tendinitis; In the wrist and hand involving: DeQuervains tenosynovitis, tendinitis, ligament tears; In the elbow involving: tennis elbow and golfers elbow; the hip involving iliotibial band tendinitis (ITB Syndrome), ilio-psoas tendinitis and bursitis, greater trochanteric bursitis, sacroiliac joint dysfunction; the knee involving: patellar tendinitis, partially torn or strained major knee ligaments (LCL/MCL); the ankle and foot involving: Achilles tendinitis, peroneal tendinitis, recurrent ankle sprains, and other foot or ankle tendinitis; neck and back involving: facet joint arthritis, rib problems. I believe PRP treatment is best reserved for incomplete, chronic degeneration and tears of extra-articular ligaments and tendons. I also believe that ultrasound guidance is essential to accuracy of placement and enhancing efficacy of the injection. More research is needed to determine the best use and protocol for successful application of this, admittedly, emerging technique.

Orthopaedic Specialists of North Carolina believes that implementing PRP therapy as a viable procedure may: decrease the progression of more serious injuries, decrease the overall time for healing, and ultimately decrease the overall need for surgical intervention. This promising adjunctive form of therapy holds the potential of healing previously problematic chronic injuries, provide a treatment option for debilitating injuries previously deemed untreatable, and serve as an alternative to surgical intervention.

Written by Dr. Mark W. Galland, Orthopaedic Surgery and Sports Medicine

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What is PRP therapy? | OrthoNC