Platelet-Rich Plasma (PRP)
During the past several years, much has been written about a preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of injuries.
Many famous athletes Tiger Woods, tennis star Rafael Nadal, and several others have received PRP for various problems, such as sprained knees and chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, or even surgery. Some athletes have credited PRP with their being able to return more quickly to competition.
Even though PRP has received extensive publicity, there are still lingering questions about it, such as:
Although blood is mainly a liquid (called plasma), it also contains small solid components (red cells, white cells, and platelets.) The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are very important in the healing of injuries.
PRP is plasma with many more platelets than what is typically found in blood. The concentration of platelets and, thereby, the concentration of growth factors can be 5 to 10 times greater (or richer) than usual.
To develop a PRP preparation, blood must first be drawn from a patient. The platelets are separated from other blood cells and their concentration is increased during a process called centrifugation. Then the increased concentration of platelets is combined with the remaining blood.
Although it is not exactly clear how PRP works, laboratory studies have shown that the increased concentration of growth factors in PRP can potentially speed up the healing process.
To speed healing, the injury site is treated with the PRP preparation. This can be done in one of two ways:
Research studies are currently being conducted to evaluate the effectiveness of PRP treatment. At this time, the results of these studies are inconclusive because the effectiveness of PRP therapy can vary. Factors that can influence the effectiveness of PRP treatment include:
According to the research studies currently reported, PRP is most effective in the treatment of chronic tendon injuries, especially tennis elbow, a very common injury of the tendons on the outside of the elbow.
The use of PRP for other chronic tendon injuries such as chronic Achilles tendonitis or inflammation of the patellar tendon at the knee (jumper's knee) is promising. However, it is difficult to say at this time that PRP therapy is any more effective than traditional treatment of these problems.
Much of the publicity PRP therapy has received has been about the treatment of acute sports injuries, such as ligament and muscle injuries. PRP has been used to treat professional athletes with common sports injuries like pulled hamstring muscles in the thigh and knee sprains. There is no definitive scientific evidence, however, that PRP therapy actually improves the healing process in these types of injuries.
More recently, PRP has been used during certain types of surgery to help tissues heal. It was first thought to be beneficial in shoulder surgery to repair torn rotator cuff tendons. However, the results so far show little or no benefit when PRP is used in these types of surgical procedures.
Surgery to repair torn knee ligaments, especially the anterior cruciate ligament (ACL) is another area where PRP has been applied. At this time, there appears to be little or no benefit from using PRP in this instance.
Some initial research is being done to evaluate the effectiveness of PRP in the treatment of the arthritic knee. It is still too soon to determine if this form of treatment will be any more effective than current treatment methods.
PRP has been used in a very limited way to speed the healing of broken bones. So far, it has shown no significant benefit.
Treatment with PRP could hold promise, however, current research studies to back up the claims in the media are lacking. Although PRP does appear to be effective in the treatment of chronic tendon injuries about the elbow, the medical community needs more scientific evidence before it can determine whether PRP therapy is truly effective in other conditions.
Even though the success of PRP therapy is still questionable, the risks associated with it are minimal: There may be increased pain at the injection site, but the incidence of other problems infection, tissue damage, nerve injuries appears to be no different from that associated with cortisone injections.
If you are considering treatment with PRP, be sure to check your eligibility with your health insurance carrier. Few insurance plans, including workers' compensation plans, provide even partial reimbursement.
Platelet-Rich Plasma (PRP) - OrthoInfo - AAOS
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