Ask a Vail Sports Doc column: Cartilage restoration techniques for the knee – Vail Daily News

Residents and visitors to the Vail Valley like to play hard, whether it be tracking one's vertical feet on a powder day or participating in the Vail Hill Climb.

I think it is great to be active and push one's limits beyond what we might have thought ourselves capable of. As we get older, most of us confront some "wear and tear" arthritis issues, myself included. One of the more common places to develop arthritis is in the knee, particularly under the knee cap, or in what is known as the patellofemoral joint.

Osteoarthritis is a process in which there is a loss of articular cartilage. I explain to my patients that articular cartilage is the white coating cartilage you would see on the end of a chicken bone. We have the same sort of cartilage on the ends of our bones.

When you wear this cartilage down, much like wearing the tread down on your tires, you have osteoarthritis or "wear and tear" arthritis. I tell my patients that restoring lost coating cartilage to our joints is the Holy Grail of orthopedics. We are not there yet, but we continue to make advances in the field of regenerative medicine.

For patients who have failed non-surgical management of their arthritis, who suffer from significant pain and/or swelling, and who are no longer able to do the activities they enjoy, there are better surgical options than there were in the past to treat cartilage defects.

Many patients are under the impression that they can have stem cells injected into their knees and new cartilage will grow and their arthritis will be cured. Unfortunately, that is not true as of today. Sadly, there are some unscrupulous practitioners out there who will gladly charge you a lot of money and suggest as much. However, I increasingly utilize stem cells and platelet rich plasma injections given growing evidence of its efficacy in the orthopedic literature. Stem cell injections and PRP injections can definitely modulate and help control the symptoms of arthritis (please see my recent article on regenerative medicine), but not cure it as of 2017.

OTHER OPTIONS

For patients who have failed non-surgical management of their arthritis, who suffer from significant pain and/or swelling, and who are no longer able to do the activities they enjoy, there are better surgical options than there were in the past to treat cartilage defects.

Autologous chondrocyte implantation is the most well established and widely used biologic cartilage cell transplantation technique. I have some patients who are 10-plus years out from this surgery and exhibit minimal cartilage wear.

In this technique, two Tic Tac size pieces of bone and overlying cartilage are harvested from the edges of the knee joint. The cells are sent for culture and the chondrocytes (articular cartilage cells) are expanded. The FDA recently permitted an exciting advancement in the technique whereby the cells are seeded onto a 3-D biologic scaffold and then this is implanted into the defect.

Osteochondral transplantation is a technique in which a core of normal cartilage and underlying bone is taken from a non-weightbearing portion of the knee or taken from a donor knee. The area of worn cartilage and an equal amount of bone is removed from the patient's knee with a coring device and the new cartilage and bone is implanted in the defect. With patients, I liken it to moving the hole on a putting green from one place to another and putting new grass where there once was dirt.

Of these two techniques, I typically recommend autologous chondrocyte implantation in those patients who are candidates as the underlying bone is not violated, normal areas of cartilage in the knee are not disturbed, the normal contours of the cartilage can be better reproduced, and the cartilage cells are more viable compared to the osteochondral transplantation technique which utilizes donor cartilage cells.

Dr. Rick Cunningham is a knee and shoulder sports medicine specialist with Vail-Summit Orthopaedics. He is a physician for the U.S. Ski Team. Do you have a sports medicine question you'd like him to answer in this column? Visit his website at http://www.vailknee.com to submit your topic idea. For more information about Vail-Summit Orthopaedics, visit http://www.vsortho.com.

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Ask a Vail Sports Doc column: Cartilage restoration techniques for the knee - Vail Daily News

Surgery fit for a human, helps a gorilla feel more in his prime – WGN-TV

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BROOKFIELD, Ill. - 49 years is not often considered "elderly. That is, unless you are a gorilla. At 49, in the primate world, if you are still alive, you are most certainly, living out your golden years.

One such gorilla at the Brookfield Zoo is doing just that.

Ramar is an aging Silverback gorilla and is slowing down every day because his knees are failing.

At 375 pounds and decades of wear and tear veterinarians compare his physical state to an NFL player in their 80s.

So doctors declared surgery is a must to clean out and even improve the aging knees of this incredible animal.

Dr. Michael Adkesson at the Brookfield Zoo invited Dr. Mukund Komanduri, an MD and orthopedic surgeon, to help him get Ramar back on his feet and moving more comfortably again.

"Its interesting. A gorilla knee is just like a human knee probably about the size of a linebacker's knee by a 300 pound guy, Dr. Komanduri said.

Six veterinarians and one human doctor along with 25 or so support staff got Ramar sedated and set for surgery in what was a very busy operating room.

First, there was some fairly routine dental work that included pulling a bad molar.

But the real task was tackling those nagging knees by performing a bilateral arthroscopy, partial removal of the gorilla's meniscus and then injections with synthetic lubricants and a platelet rich plasma to reduce inflammation.

There are minimally invasive procedures medical teams knew were necessary after Ramar stopped moving around his exhibit the way he used to.

After drugs like Lyrica and Celebrex stopped providing relief, it was time for another approach. The apes are taking meds like humans and now the gorillas in captivity are living longer just like us, too. The surgery took between two and three hours to complete. Ramar was wheeled back to his habitat and the team working on him are hopeful their efforts will give this old primate new purpose in his retirement years.

"Hes in fantastic health overall and we expect him to bounce back from this procedure very quickly," Dr. Adkesson said.

More information at Brookfield Zoo.

41.834102 -87.833503

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Surgery fit for a human, helps a gorilla feel more in his prime - WGN-TV

Platelet Rich Plasma Therapy and Osteoarthritis – PRP …

Recently, emerging evidence has suggested that Platelet Rich Plasma (PRP) may also be of assistance in the treatment of osteoarthritis and other degenerative conditions of joints. It is felt that the growth factors may assist in cartilage regeneration and also mediate benefit by providing an immune modulating effect, whereby the inflammatory cascade is dampened. Thus, PRP may act as a natural anti-inflammatory substance to result in symptomatic pain relief of sore arthritic joints.

The process of obtaining PRP for use in treatment of osteoarthritis of joints is identical to that outlined for PRP injections of tendons.

Patients and referring clinicians may have recently become aware of this procedure in the media: (ACA "New Knees", Friday, August 30, 2013 - http://aca.ninemsn.com.au/article.aspx?id=8715252) and may therefore find our fact sheet on PRP injections of further assistance.

An ultrasound machine is used to guide the safe and accurate delivery of PRP into a patients arthritic knee.

For more information read: Melbourne Radiology Clinic - Patient Fact Sheet: Autologous Blood Injection & Platelet Rich Plasma Injections

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Platelet Rich Plasma Therapy and Osteoarthritis - PRP ...

Platelet Rich Plasma – L.A. Beauty Skin Center

Is your skin tone simply not as healthy and smooth as on previous occasions? Have you noted fine lines and sagging skin around your eyes, cheeks and mouth? Are you conscious of the puffiness and dark circles below your eyes? The best recommended solution to these types of skin issues is Platelet Rich Plasma therapy. PRP is an advanced treatment technology that utilizes ingredients present in an individuals blood in order to regenerate their skin and revitalize collagen, leading to healthy, young looking skin.

Platelet Rich Plasma has a protracted history of being applied in dentistry, reconstructive surgery and orthopedic medicine. Today, it is also being used in other branches of medicine including dermatology, cosmetic facial rejuvenation and skin wound healing. Scientific studies ever since have proven that PRP generates new collagen when infused into the skin and recent studies reveal that PRP can ease sun damage as well as aging skin problems.

PRP is basically a natural product produced from your own body. Through a simple blood draw, a little amount of blood is drawn from an individual into a sterile tube. Using a unique centrifuge machine, the blood is spun down in order to take out and concentrate the stem cells, growth factors and platelets that are very important for tissue healing. This little amount of blood with a high concentration of platelets and growth factors is referred to as Platelet Rich Plasma (PRP).

PRP is best known for its wonderful act of skin rejuvenation. When PRP is injected into particular parts of the skin, its high platelet concentration functions as a matrix that stimulates the growth of new collagen, revitalizes skin tissue and hence leads to a naturally smooth and firm skin. As a result, PRP treatment gets rid of wrinkles and creates a smoother skin feel and tone.

There is a huge difference between PRP therapy and other skin injections of fillers. Most fillers including Juvederm and Restylane are composed of solid material which fills skin lines and folds. They often last for short period of time and require repeated treatments to seal the area yet again. On the other hand, PRP fuels collagen growth for absolute facial rejuvenation instead of individual wrinkle enhancement. Platelet Rich Plasma therapy is recommended for faces that appear drawn, to soften below eye puffiness, enhance the overall skin tone, texture and tightness and seal skin areas where fillers are not able to reach. Fillers such as Juvederm and Restylane can be applied together with PRP given that the two forms of skin treatment actually serve different purposes. The fillers will fill particular wrinkles while PRP will enhance overall wrinkle improvement.

There is enough evidence to show that Platelet Rich Plasma can be used to treat several skin issues such as Diabetic foot ulcers, bedsores, thermal burns, hair loss, superficial and surgical injuries and skin graft donor sites. Others include facial rejuvenation and post-traumatic scars.

For optimal results, LA Beauty Skin Center is the best place to have your PRP cosmetic treatment. Improvement of the skin tone and elasticity will be visible immediately after treatment. To maintain your skin and face looking young, make follow-up PRP treatments at LA Beauty Skin Center.

Current Price

Full Face + micro needling $950

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Platelet-rich plasma: intra-articular knee injections …

Platelet-rich plasma (PRP) is a natural concentrate of autologous blood growth factors experimented in different fields of medicine in order to test its potential to enhance tissue regeneration. The aim of our study is to explore this novel approach to treat degenerative lesions of articular cartilage of the knee. One hundred consecutive patients, affected by chronic degenerative condition of the knee, were treated with PRP intra-articular injections (115 knees treated). The procedure consisted of 150-ml of venous blood collected and twice centrifugated: 3 PRP units of 5 ml each were used for the injections. Patients were clinically prospectively evaluated before and at the end of the treatment, and at 6 and 12 months follow-up. IKDC, objective and subjective, and EQ VAS were used for clinical evaluation. Statistical analysis was performed to evaluate the significance of sex, age, grade of OA and BMI. A statistically significant improvement of all clinical scores was obtained from the basal evaluation to the end of the therapy and at 6-12 months follow-up (P < 0.0005). The results remained stable from the end of the therapy to 6 months follow up, whereas they became significantly worse at 12 months follow up (P = 0.02), even if still significantly higher respect to the basal level (P < 0.0005). The preliminary results indicate that the treatment with PRP injections is safe and has the potential to reduce pain and improve knee function and quality of live in younger patients with low degree of articular degeneration.

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Platelet-rich plasma – Wikipedia

Platelet-rich plasma (abbreviation: PRP) is blood plasma that has been enriched with platelets. As a concentrated source of autologous platelets, PRP contains several different growth factors and other cytokines that can stimulate healing of soft tissue. Platelet-rich plasma therapy is an old therapy and used extensively in specialities of dermatology, orthopedics and dentistry. Platelet rich plasma therapy utilizes growth factors present in alpha granules of platelets in an autologous manner. Main indications in dermatology for PRP are androgenetic alopecia, wound healing, face rejuvenation etc. For preparation of PRP, various protocols are used and no standard protocol exists but main principles essentially involve concentrating platlets in a concentration of 35 times the physiological value and then injecting this concentrated plasma in the tissue where healing or effect is desired.[1] As of 2016, no large-scale randomized controlled trials have confirmed the efficacy of PRP as a treatment for musculoskeletal or nerve injuries, the accelerated healing of bone grafts, or the reduction of androgenic hair loss.

PRP was first developed in the 1970s and first used in Italy in 1987 in an open heart surgery procedure.[citation needed] PRP therapy began gaining popularity[where?] in the mid 1990s.[citation needed] It has since been applied to many different medical fields such as cosmetic surgery, dentistry, sports medicine and pain management.[citation needed]

The number of peer reviewed publications studying the PRP's efficacy has increased dramatically since 2007.[2]

The efficacy of certain growth factors in healing various injuries and the concentrations of these growth factors found within PRP are the theoretical basis for the use of PRP in tissue repair.[3] The platelets collected in PRP are activated by the addition of thrombin and calcium chloride, which induces the release of the mentioned factors from alpha granules. The growth factors and other cytokines present in PRP include:[3][4]

As of 2009[update] there have been two PRP preparation methods approved by the U.S. Food and Drug Administration.[5] Both processes involve the collection of the patient's whole blood (that is anticoagulated with citrate dextrose) before undergoing two stages of centrifugation (TruPRP) (Harvest) (Pure PRP) designed to separate the PRP aliquot from platelet-poor plasma and red blood cells.[5] In humans, the typical baseline blood platelet count is approximately 200,000 per L; therapeutic PRP concentrates the platelets by roughly five-fold.[6] There is broad variability in the production of PRP by various concentrating equipment and techniques.[7][8][9]

In humans, PRP has been investigated and used as a clinical tool for several types of medical treatments, including nerve injury,[4] chronic tendinitis,[10][11][12]plantar fasciitis,[13]osteoarthritis,[14]cardiac muscle injury,[15] and androgenic alopecia,[16][17] for bone repair and regeneration,[18] in plastic surgery,[19]colorectal surgery[20] and oral surgery[21]

PRP has received attention in the popular media as a result of its use in treating sports injuries in professional athletes.[22][23][24][25]

The cost of a PRP treatment in the U.S. has been quoted as $1000 out-of-pocket expenses, as it is usually not covered by health insurance.[25]

PRP has been used experimentally in the treatment of empty nose syndrome[26]

As of 2016[update] results of basic science and preclinical trials have not yet been confirmed in large-scale randomized controlled trials. A 2009 systematic review of the scientific literature found there were few randomized controlled trials that adequately evaluated the safety and efficacy of PRP treatments and concluded that PRP was "a promising, but not proven, treatment option for joint, tendon, ligament, and muscle injuries".[27]

A 2010 Cochrane analysis on PRP use in sinus lifts during dental implant placement found no evidence that PRP offered any benefit.[21]

As of 2011, PRP use for nerve injury and sports medicine has produced "promising" but "inconsistent" results in early trials.[4]

A 2013 review stated more evidence was needed to determine PRP's effectiveness for hair regrowth.[28]

A 2014 Cochrane analysis for PRT use to treat musculoskeletal injuries found very weak (very low quality) evidence for a decrease in pain in the short term, up to three months and no difference in function in the short, medium or long term. There was weak evidence that suggested that harm occurred at comparable, low rates in treated and untreated people.[29]

A 2016 systematic review and meta-analysis of randomized controlled clinical trials for PRP use to augment bone graft found only one study reporting a significant difference in bone augmentation, while four studies found no significant difference.[30]

Since 2004, proponents of PRP therapy have argued that negative clinical results are associated with poor-quality PRP produced by inadequate single spin devices. The fact that most gathering devices capture a percentage of a given thrombocyte count could bias results, because of inter-individual variability in the platelet concentration of human plasma and more would not necessarily be better.[6] The variability in platelet concentrating techniques may alter platelet degranulation characteristics that could affect clinical outcomes.[4]

Platelet-rich plasma is used in horses for treatment of equine lameness due to tendon and ligament injury, wounds, fractures, bone cysts, and osteoarthritis.[citation needed]

Some concern exists as to whether PRP treatments violate anti-doping rules.[3] As of 2010 it was not clear if local injections of PRP could have a systemic impact on circulating cytokine levels, affecting doping tests and whether PRP treatments have systemic anabolic effects or affect performance.[3] In January 2011, the World Anti-Doping Agency removed intramuscular injections of PRP from its prohibitions after determining that there is a "lack of any current evidence concerning the use of these methods for purposes of performance enhancement".[31]

According to the Baltimore Sun, Zach Britton had PRP injections in his left shoulder in March 2012, Orioles first baseman Chris Davis underwent two PRP injections to speed the healing and recovery of an oblique injury in April 2014, and Dylan Bundy had the procedure in April before undergoing Tommy John surgery in June 2014.[32]

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Platelet-rich plasma - Wikipedia

Connecticut & New England PRP Platelet-Rich Plasma …

What is PRP?

Maybe the acronym PRP is unfamiliar to you; its one of the newer sports injury treatments. We work with patients throughout New England and the Northeast and beyond by using PRP as one of our treatments. Our doctors are experts at using these treatments and can get you relief from your sports injury fast. Please read on to find out more about PRP available from Valley Sports Physicians & Orthopedic Medicine. You can also call us at (860) 430-9690 to learn more and schedule an appointment.

PRP, or platelet-rich plasma, is a revolutionary new treatment for chronic sports and musculoskeletal injuries that is taking the sports medicine and orthopedic community by storm. Professional and recreational athletes alike credit PRP treatment for enabling them to get back in the game, and patients with joint arthritis are experiencing less pain and greater function.

Dr. Tortland has been performing PRP treatments since December 2007, making him among the firstand most experiencedphysicians in the country offering this treatment.

Platelets are a specialized type of blood cell. Blood is made up of 93% red cells (RBCs), 6% platelets, 1% white blood cells (WBCs), and plasma. The goal of PRP is to maximize the number or concentration of platelets while minimizing the number of RBCs. Generally speaking, the higher the concentration of platelets, the better.

Unlike many other practices, at Valley Sports Physicians all of our PRP injections are given under direct ultrasound guidance to insure accurate placement of the platelet concentrate in the damaged area. In fact, Drs. Tortland is anationally-recognized expert in musculoskeletal ultrasound.

The entire treatment, from blood draw, to solution preparation, to injection, takes 30-40 minutes. Before injections are given the skin and underlying tissue is first anesthetized to minimize the discomfort.

Currently there are over half a dozen companies making & selling commercial PRP preparation systems, of course with each company claiming that their PRP is the best! PRP products can vary widely in terms of platelet concentrations, the presence or absence of red blood cells (RBCs), the presence/absence of white blood cells (WBCs), and the volume of PRP created.

Some PRP is not much better than whole blood or platelet poor plasma, with very low platelet concentrations. Much of the commercial PRP is rich in RBCs, which have been shown to kill as many as 15% of synovial cells inside a joint. Many PRP products contain high amounts of inflammatory WBCs, contributing to increased post-injection pain.

At Valley Sports Physicians we spent a year researching and pioneering a new method of creating a high quality PRP, containing an average of 1.5 million platelets per microliter (well above the commercial PRP average), essentially free of RBCs, and containing helpful pro-growth WBCs while eliminating the inflammatory WBCs. Our method was validated via independent clinical laboratory testing. So you can be assured that the PRP product you receive from us is the absolute highest quality, purity, and effectiveness currently available. When youre spending hundreds of dollars on a treatment, you want to be sure that youre getting the best possible product!

In most cases, after the initial treatment, a follow up visit is scheduled 6-8 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 8-12 weeks on average. In rare cases, such as more severe hip arthritis, PRP injections may be given once every 4 weeks for 2-3 treatments.

PRP treatment works best for chronic ligament and tendon sprains/strains that have failed other conservative treatment, including:

In addition, PRP can be very helpful for many cases of osteoarthritis (the wear & tear kind). PRP can help stimulate a smoothing over of the roughened and arthritic cartilage, reducing the pain and disability of arthritis. This includes:

Most insurance plans, including Medicare, do NOT pay for PRP injections.

The level of discomfort of the treatment depends in part on the area being treated. For example, injections given into a joint often are minimally uncomfortable and in some cases painless. Injections given into tendons tend to be more uncomfortable. There is usually moderate pain for the next few days.

For the first week after the injections it is critical to avoid anti-inflammatory medications, including Advil, Motrin, ibuprofen, Aleve, Celebrex, and Mobic. These will interfere with the healing response. Tylenol is OK. Your doctor may prescribe pain medication also for post-injection discomfort.

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.

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

Studies suggest an improvement of 80-85%, though some arthritic joints, namely the hip, do not respond as well. Some patients experience complete relief of their pain. In the case of tendon and ligament injuries the results are generally permanent. In the case of joint arthritis, how long the treatment lasts depends partly on the severity of the condition. Mild arthritis may not need another round of treatments. More advanced arthritis, on the other hand, typically requires a repeat course of treatment, usually in 1-3 years.

The goal of PRP treatment is to reduce pain and to improve function. While there is some weak evidence that treatment occasionally does result in increased cartilage thickness, the important point to keep in mind is that the cartilage lining the joint surfaces has no pain fibers! For example, often we see patients with knee or hip arthritis where the joint that does NOT hurt has WORSE arthritis on x-ray! Pain from arthritis is very complex and involves far more than just how thick the cartilage is.

At Valley Sports Physicians the cost of PRP treatment is based on the level of complexity involved in treating a given area(s). Prices range from $700 to $1100 per treatment. If two joints or areas are treated at the same time, the cost is NOT double there is a slight increase.

The last 10 years has seen an explosion in research dedicated to investigating the potential benefits of PRP. One problem with PRP research, however, is that often investigators do not specify what the quality & character of the PRP used. See the discussion above, Not All PRP is the Same!

Below are some summaries from a few representative research studies:

Tennis Elbow:

Peerbooms et al in 2010 compared a single PRP injection to a cortisone injection for the treatment of chronic tennis elbow. 51 patients received the PRP injection while 49 received a cortisone injection. At one year follow up 73% of the PRP subjects were significantly better, compared to only 51% of the cortisone injection subjects. Of note was the observation that those receiving the cortisone injection felt better initially than the PRP group, whereas the PRP group progressively improved. Their conclusion: Treatment of patients with chronic lateral epicondylitis with PRP reduces pain and significantly increases function, exceeding the effect of corticosteroid injection. (Peerbooms et al. Positive effect of an autologous platelet concentrate in lateral epicondylitis in a double-blind randomized controlled trial. Am J Sports Med. 2010;38(2):255-262).

In a 2011 study by Hechtman & colleagues, 30 patients (31 elbows) with epicondylitis unresponsive to nonsurgical treatment (including steroid injection) for >6 months received a single PRP injection. Results: Patient satisfaction scores improved from 5.12.5 at 1 month to 9.11.9 (on a scale of 1-10) at 1-year follow-up. Only 1 patient reported no improvement after 6 months. Results suggest that a single platelet-rich plasma injection can improve pain and function scores, thus avoiding surgery. (Hechtman et al. Platelet-rich plasma injection reduces pain in patients with recalcitrant epicondylitis. Orthopedics. 2011 Jan 1;34(2):92.

Rotator Cuff:

In 2012 Rha & associates compared PRP treatment to dry needling for the treatment of chronic rotator cuff tendinitis. 39 patients were randomized to receive either 2 PRP injections 4 weeks apart, or 2 dry needling treatments, also 4 weeks apart. All treatments were done under ultrasound guidance. Conclusions: Autologous platelet-rich plasma injections lead to a progressive reduction in the pain and disability when compared to dry needling. This benefit is certainly still present at six months after treatment. These findings suggest that treatment with platelet-rich plasma injections is safe and useful for rotator cuff disease. (Rha et al. Comparison of the therapeutic effects of ultrasound guided platelet-rich plasma injection and dry needling in rotator cuff disease: A randomized controlled trial. Clin Rehab. 2012;27(2):113-122.)

Chronic Plantar Fasciitis:

Monto in 2014 looked at the effectiveness of PRP for recalcitrant plantar fasciitis. Forty patients (23 females and 17 males) with unilateral chronic plantar fasciitis that did not respond to a minimum of 4 months of standardized traditional nonoperative treatment modalities were prospectively randomized and treated with either a single ultrasound guided injection of 3 cc PRP or 40 mg DepoMedrol cortisone. Patients were evaluated at 3, 6, 12, and 24 month after treatment. Those receiving the cortisone injection felt better initially than the PRP group, but their improved waned and their pain returned completely to baseline by 12 months. Those in the PRP group, on the other hand, continued to experience gradual improvement and were markedly better at 12 and 24 months. Conclusion: PRP was more effective and durable than cortisone injection for the treatment of chronic recalcitrant cases of plantar fasciitis. (Monto RR. Platelet-rich plasma efficacy versus corticosteroid injection treatment for chronic severe plantar fasciitis. Foot & Ankle International. 2014;35(40):313-318.)

Hamstring Injuries:

A 2014 study by Hamid et al looked at effectiveness of PRP injections for Grade 2 hamstring injuries. 28 patients with acute hamstring injuries were randomly assigned to receive either a PRP injection in combination with a rehab program, or a rehab program only. The primary outcome measure was time to return to play, while secondary measurements included pain severity and interference with activity from pain. Results: Patients in the PRP group had an average return to play time of 27 days, while the rehab-only group took 42 days. The PRP group also had significantly lower pain scores throughout the study. (Hamid et al. Platelet-rich plasma injections for the treatment of hamstring injuries: a randomized controlled trial. Am J Sports Med. 2014;42(10):2410-2418.)

Patellar Tendinitis:

Volpi et al treated the affected knees of 8 athletes (10 knees) with chronic patellar tendinosis that had failed to respond to conservative treatment and who were considering surgical intervention. Patients received a single ultrasound-guided PRP injection into the damage patellar tendon. At follow up in 120 days all subjects reported an average 91% improvement, and MRI showed interval healing. (Volpi et al. Treatment of chronic patellar tendinosis with buffered platelet-rich plasma: a preliminary study. Medsport. 2007;60:595-603.)

Knee Arthritis:

Cerza & associates compared PRP injections to hyaluronic acid (HA) injections for the treatment of knee osteoarthritis in 2012. 120 patients were randomly divided into 2 groups. One group received 4 weekly injections of PRP, while the other group received 4 weekly injections of HA. Patients were evaluated at 4, 12 and 24 weeks after the 1st injection. Results: Treatment with PRP showed a statistically significant better clinical outcome than did treatment with HA. Of note was that patients with more severe arthritis (Grade III-IV) did not see improvement with HA, whereas severity of disease did not matter with respect to improvement with the PRP. (Cerza et al. Comparison between hyaluronic acid and platelet-rich plasma, intra-articular infiltration in the treatment of gonarthrosis. Am J Sports Med. 2012;40(12):2822-2827.)

Gobbi et al also looked at the effectiveness of PRP for knee osteoarthritis. 50 patients were treated with 2 PRP injections, 1 month apart. 25 patients had previously undergone surgery for cartilage lesions. Results: All patients showed significant improvement in all measured scores at 6 & 12 months and returned to previous activities. No difference in improvement was found among various subgroups (prior surgery vs. no surgery, severity of disease, age). (Gobbi et al. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: Preliminary results in a group of active patients. Sports Health. 2012;4(2):162-172.)

Hip Arthritis:

Sanchez & co. looked at PRP for hip osteoarthritis in 2012. 40 patients with severe hip were included. Each subject received an injection of PRP into the affected hip once a week x 3 weeks. Patients were evaluated at 7 weeks and 6 months. 60% of subjects reported a positive response (characterized by at least a 30% improvement in symptoms). 40% of those who had a favorable response were classified as excellent responders. Conclusions: This preliminary non-controlled randomized prospective study supported the safety, tolerability and efficacy of PRP injections for pain relief and improved function in a limited number of patients with OA of the hip. (Sanchez et al. Ultrasound-guided platelet-rich plasma injections for the treatment of osteoarthritis of the hip. Rheumatology. 2012;51:141-150.)

Healing is a caloric-demanding task. The body expends energy trying to repair itself. It is important, therefore, to optimize your nutritional status, preferably before you undergo treatment. Ensuring adequate protein, eliminating (or at least significantly reducing) consumption of sugar and sugar-containing products, and adding healthy fats are essential components of a healing diet. Specifically, minimum protein intake consists of at least 0.5g protein per pound of body weight per day. For a 150 lb person thats 75 grams of protein daily, evenly divided among breakfast, lunch, dinner, and an evening snack. If you exercise your protein needs go up, to as much as 1.0g per pound of body weight daily.

As a general rule of thumb, 1 oz of chicken, beef, or pork contains 7 grams of protein, wheres fish has 5 grams per ounce. For a more complete discussion of protein requirements, see AuthorityNutrition.com.

Healthy fats include avocado, organic coconut oil, olive oil, organic peanut butter, organic butter, and organic raw (not pasteurized) milk. Contrary to popular belief, eating fat does NOT make you fat.

To get maximum benefit from the treatment, and to help prevent re-injury, a specially-designed rehabilitation and exercise program may incorporated into your treatment. This helps the newly developing connective tissue mature into healthy and strong tendon or ligament fibers. In addition, nutritional support, such as glucosamine, MSM, and increased protein intake can help the healing process.

PRP can be a very effective and relatively cost-efficient treatment alternative for persons suffering from painful musculoskeletal conditions. However, because it is still a relatively new treatment, there are many practitioners who are newcomers to the party. Therefore, it is important that patients choose a practitioner who:

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Connecticut & New England PRP Platelet-Rich Plasma ...

What is PRP therapy? | OrthoNC

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

Platelet Rich Plasma – Biocellular Renerative Medicine

OPTIMUM PLATELET CONCENTRATION LEVEL FOR PRP Outpatient PRP preparation systems exist with the ability to concentrate platelets from two to eight times. There is some controversy about what the optimum platelet concentration should be, but a level of at least 1 million platelets per L appears to be the magic number. Since the average patients platelet count is 200,000 +/- 75, a four to five times concentration appears to be the desired level. When levels are in the 5x range, the influx of adult stem cells has been noted to increase by over 200%. In 2008, Kajikawa et al concluded that PRP enhances the initial mobilization of circulation-derived cells in the early stage of tendon healing. Circulation-derived cells are defined as mesenchymal stem cells that have the potential to differentiate into reparative fibroblasts or tenocytes as well as macrophages. Under normal circumstances, circulation-derived cells last only a short time after tendon injury. The authors suggest this as one of the main reasons for the known low healing ability of injured tendons. If the circulation derived cells could be activated and their time-dependant decrease stalled with PRP, then the wounded tendon could more fully heal. One study found an increase in the circulation-derived cells with the PRP group, as well as increased production of types I and III collagen in the PRP group versus control. This finding of additional fibroblast proliferation and type I collagen production enhanced by increasing platelet concentrations concur with an earlier study by Lui et al. This provides evidence that PRP stimulates the chemotactic migration of human mesenchymal stem cells to the injury site in a dose-dependent manner - i.e., the more concentrated the platelets, the more stimulation.

PROLOTHERAPY VERSUS PRP The use of hyperosmolar dextrose (Prolotherapy) has been shown to increase platelet-derived growth factor expression and upregulate multiple mitogenic factors that may act as signaling mechanisms in tendon repair. Saline Prolotherapy can have a similar effect. An interesting study published in the January 2010 JAMA compared PRP versus saline injection (basically saline Prolotherapy) for chronic Achilles tendinopathy. Both groups improved significantly by Yellonel et al and the authors conclude there was no statistical difference between the improvement of both groups. Therefore, both PRP and Prolotherapy have been shown to stimulate natural healing and both can be effective and both should be considered in the treatment plan for connective tissue repair. However, PRP may be more appropriate in some cases. When PRP is used as a Prolotherapy formula for chronic or longstanding injuries, the PRP increases the initial healing factors and thereby the rate of healing. The Prolotherapy itself (irritation, needle microtrauma) is what is tricking the body into initiating repair at these long forgotten sites as well as the PRP, itself, which also acts as an irritating solution. This is especially important with chronic injuries, degeneration and severe tendonosis, where the body has stopped recognizing that area as something to repair. In these cases, PRP may be more appropriate, however this determination should be made by the physician on an individual basis. PRP can also be used preferentially over dextrose Prolotherapy in the case of a tendon sheath or muscle injury- areas occasionally but not typically treated with dextrose Prolotherapy where the focus is the fibroosseous junction (enthesis). It can also be used preferentially over dextrose Prolotherapy because of patient preference.

WHOLE BLOOD INJECTIONS VERSUS PRP Even before PRP, it was not unheard of to use whole blood as a Prolotherapy solution, especially where the patient was hypersensitive to other formulas. A 2006 study in the British Journal of Sports Medicine studied the use of whole blood with needling(irritation such as with Prolotherapy) and concluded that the use of autologous blood injection, combined with dry needling, appears to be an effective treatment for medial epicondylitis. Another study in that same journal in 2009 compared injections using whole blood, dextrose Prolotherapy, platelet rich plasma and polidocanol (a sclerosing agent), and concluded that there is evidence to support the use of each of these agents in the treatment of connective tissue damage. However, there are only three known studies using whole blood, all of which were prospective case series without controls and small patient numbers. PRP studies, on the other hand, are growing not only in number, but also in quality. When examining the physiology of how activated platelets signal repair cells, it seems logical that using PRP (with higher levels of platelets per unit volume) would be more effective than autologous blood although no study has yet directly compared the two.

CORTISONE VERSUS PRP The use of cortisone in musculoskeletal injuries is controversial and the subject of various studies over the years. In February 2010, researchers in the Netherlands published the results of a well designed, two year randomized controlled blinded trial with a significant test group of 100 patients, comparing corticosteroid use to an injection of concentrated platelet rich plasma without ultrasound guidance. The PRP injection was given to the lateral epicondyle area of maximum tenderness, and a peppering technique was used in order to activate the thrombin release from the tendon- in this case endogenous thrombin is the activator for the injected platelet growth factors. The researchers indicate the importance of the inflammation phase the first two days post treatment) during which there is a migration of macrophages to the injured tissue site. Macrophages release additional growth factors, and there is increased collagen synthesis on days three to five. The conclusion of the Netherlands study was that PRP reduces pain and significantly increases function, exceeding the effect of the corticosteroid injection.

SAFETY ISSUES Like Prolotherapy, PRP therapy has low risk and few side effects. Concerns such as hyperplasia have been raised regarding the use of growth factors, however there have been no documented cases of carcinogenesis, hyperplasia, or tumor growth associated with the use of autologous PRP. PRP growth factors never enter the cell or its nucleus and act through the stimulation of external cell membrane receptors of adult mesenchymal stem cells, fibroblasts, endothelial cells, osteoblasts, and epidermal cells. This binding stimulates expression of a normal gene repair sequence, causing normal healing - only much faster. Therefore PRP has no ability to induce tumor formation. Also, because it is an autologous sample, the risk of allergy or infectious disease is considered negligible. Evidence also exists in studies that PRP may have an antibacterial effect.

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PRP is a concentration of platelet cells from your blood with growth factors and stem cells. This helps the healing process of chronic problems or injuries. These bioactive proteins initiate connective tissue healing and promote development of new blood vessels.

By the use of the Harvest Tech System we obtain approximately 9cc's from the vein in the patient's arm. Using the special reagent tube and centrifuge the blood is spun to obtain the plasma platelets and stem cells.

First, the area to be injected is numbed so the injection doesn't hurt. Once the plasma platelets are obtained and injected into the chronic painful area this increases the platelets and growth factors 500%. It can be used for chronic foot pain such as plantar fasciitis and Achilles tendonitis.

PRP injections are not covered by insurance. The charge is $675.00 per injection. It is expensive but it can avoid surgery that is both costly and disabling. You can use your health saving plan for this service.

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PRP (Platelet Rich Plasma) Injections - Dr. Thomas F ...