For acute and chronic ligament and tendon sprains and strains, and mild arthritis, a new biologic treatment known as Platelet-Rich Plasma (PRP) is emerging as a promising therapy. At EmergeOrtho, board certified sports medicine physicians provide PRP therapy to athletes of all levels.
What is Platelet-Rich Plasma (PRP) Therapy?
Platelet-rich plasma is defined as a patient’s own blood that has been processed to result in a higher amount of platelets in the blood. Platelet-rich plasma has been used in maxillofacial and plastic surgery since the 1990s; its use in sports medicine is growing given its potential to enhance muscle and tendon healing. Studies suggest that growth factors released by platelets help to repair cells and may assist soft-tissue repair.
Why Does PRP Work?
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. Most people associate platelets with clot formation. While that certainly is an important function of platelets, they are also very much involved in injury healing.
Human platelets are naturally extremely rich in connective tissue growth factors. Injecting these growth factors into damaged ligaments, tendons, and joints stimulates a natural repair process. In order to benefit from these natural healing proteins, the platelets must first be concentrated.
In other words, PRP recreates and stimulates the body’s natural healing process. Corticosteroid or “cortisone” injections, as they are commonly referred to, cannot be injected into weight bearing tendons such as the patellar tendon of the knee and Achilles tendon of the ankle because they can weaken the tendon and cause them to rupture. PRP can safely be used in these tendons without the risk of rupture.
How is Treatment Administered? How Long is a Treatment Session?
First, blood is drawn from the patient, and then it is placed in a special machine called a centrifuge. The centrifuge separates the RBCs. Then the remaining platelets and plasma are highly concentrated. The WBCs, which comprise only a fraction of the total cells, go along for the ride with the platelets and plasma. Red blood cells are discarded, and the resulting platelet concentrate is used for treatment. In most cases the injections are given under direct ultrasound guidance to ensure accurate placement of the platelet concentrate in the damaged area. The entire treatment, from blood draw, to solution preparation, to injection, takes only 45 minutes.
How Often Do You Need Platelet-Rich Plasma Injections?
After the initial treatment, a follow up visit is scheduled 2 weeks later to evaluate healing progress. Some patients respond very well to just one treatment. However, 2-3 PRP treatments may be necessary in some injuries.
What Conditions Benefit From PRP?
PRP treatment works for acute and chronic ligament and tendon sprains/strains where other conservative treatments have failed. These include:
- Knee: Patellar Tendinitis, Patellar Femoral Syndrome, chondromalacia patella, partially torn or strained major ligaments of knee (ACL/LCL/MCL), meniscus tears, arthritis, patellar instability
- Hip: IIliotibial Band Tendinitis (ITB Syndrome), Psoas Tendinitis and bursitis, gluteus medius tendonitis, Greater Trochanteric Bursitis, Hip labrum tears, Piriformis Syndrome, Sacroiliac Joint Dysfunction, arthritis
- Shoulder: Rotator Cuff Tendinitis or Tear, Rotator Cuff Impingement Syndrome or Bursitis, Bicipital Tendinitis, labrum tears, arthritis, instability
- Wrist/Hand: De Quervain’s Tenosynovitis, arthritis, other wrist or finger tendinitis, ligament tears or dysfunction of the fingers
- Elbow: Elbow tendonitis and epicondylitis, arthritis
- Ankle/Foot: Achilles Tendinitis, Plantar fasciitis/ fasciosis, Peroneal Tendinitis, arthritis, recurrent ankle sprains, other foot or ankle tendinitis
- Other chronic tendon and ligament problems
In addition, PRP may be very helpful for osteoarthritis (“wear & tear” arthritis). PRP may help stimulate a “smoothing over” of the roughened and arthritic cartilage, reducing the pain and disability of arthritis in knees, hip joints and other joint arthritis.
Do PRP Injections Hurt?
Unlike a steroid injection, there may be pain for the next few days after an injection. For a few days before the injection and for the first week after the injections it is critical to avoid anti-inflammatory medications, including Advil, Motrin, Ibuprofen, Aleve, Celebrex and Aspirin (unless prescribed by your heart doctor). These will interfere with the healing response. Tylenol is OK. Your doctor may prescribe pain medication also.
What is the Success Rate of Platelet-Rich Plasma (PRP) Treatments?
Studies suggest an improvement of 80-85%. Some patients experience complete relief of their pain. The results are generally permanent.
What Are The Risks With PRP?
Any time 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, vary depending on the area being treated, and will be discussed by your doctor before starting treatment. Because PRP uses your own blood, adverse reactions are rare.
Is PRP Covered by Insurance?
Most insurance plans, including Medicare, do NOT pay for PRP injections.