What is Platelet Rich Plasma Therapy?
Platelet Rich Plasma Therapy using your own growth factors
In this article Ross Hauser, MD discusses new research on the clinical benefits of Platelet Rich Plasma Therapy or sometimes referred to as PRP, PRP Therapy, plasma rich platelet therapy or plasma replacement therapy. or simply PRP treatments.
The summary of a new research article adequately sums up the excitement of using Platelet Rich Plasma Therapy in repairing and regenerating cartilage. In this summary, doctors writing in the medical journal Biomed Research International say that the convincing findings of recent studies, investigating the different potentials of platelet-rich plasma, offers doctors an appealing alternative for the treatment of cartilage lesions (tears) and osteoarthritis. Evidences suggests that PRP may be helpful both as an adjuvant for surgical treatment of cartilage defects and as a therapeutic tool by intra-articular injection in patients affected by osteoarthritis. Their findings confirms the fascinating biological role of PRP.1
At Caring Medical, we specialize in proliferative injection therapies, known as Prolotherapy. While these regenerative medicine treatments have been around for many decades, one of the exciting additions, in recent years, is Platelet Rich Plasma (PRP) Therapy.
PRP has been shown effective for labral tears of the hip and shoulder labrum tears, as well as degenerated meniscus and meniscus tears. The scientific literature is full of reports of soft tissue injuries treated with PRP including tendinopathy, tendinosis, acute and chronic muscle strain, muscle fibrosis, ligament sprains and joint capsular laxity, in addition to various degenerative disorders in your joints. Especially exciting is PRP’s use for regenerating cartilage. Most recently research has shown PRP to be an effective treatment for knee osteoarthritis.
The preparation of therapeutic doses of growth factors consists of an autologous blood collection (blood from the patient), plasma separation (blood is centrifuged), and application of the plasma rich in growth factors (injecting the plasma into the area.) In other words, a PRP treatment is done just like any other Prolotherapy treatment, except the solution used for injection is plasma enriched with growth factors from your own blood. In our office, patients are generally seen every 4-6 weeks. Typically three to six visits are necessary per area.
How does Platelet Rich Plasma work?
Platelets play a central role in blood clotting and wound healing. Tissue repair begins with clot formation and platelet degranulation, which release the growth factors necessary for wound repair. Platelet-derived growth factors are biologically active substances that enhance tissue repair mechanisms.
After platelets are activated at a wound site, proteins are released that directly and indirectly influence virtually all aspects of the wound healing cascade. Studies have shown a direct correlation between the platelet concentration and the level of secretory proteins, as well as the amount of proliferation involved in the wound healing.
Specifically, PRP enhances the fibroblastic events involved in tissue healing including chemotaxis, proliferation of cells, proteosynthesis, reparation, extracellular matrix deposition, and the remodeling of tissues.
It is strongly suggested that soft tissue injuries can heal faster with Platelet Rich Plasma treatment.
Anti-inflammatory or inflammatory?
The above effects of Platelet Rich Plasma Therapy on rebuilding cartilage and soft tissue is in affect PRP awakening the inflammatory response to healing. This also causes a degree of confusion even among medical professionals. In essence they say “Do we want PRP to be an anti-inflammatory?”
This is the basis of Orthokine, an PRP “product” that reduces inflammation and tried by athletes such as Kobe Bryant and Alex Rodrigtuez. The treatment has limited appeal because it is only an anti-inflammatory and does not promote healing.
In new research, doctors tested different types of PRP formulas and they found that they may reduce inflammation when inflammation was induced by Interleukin-1, the peptide responsible for cell signaling and opening the healing pathways.2
Platelet Rich Plasma Therapy – Conflicting Evidence
In another new paper, doctors writing in the medical journal Odontology say that Platelet Rich Plasma Therapy is very promising BUT calls for a standardization for doctors who want to use Platelet Rich Plasma Therapy (PRP) in the treatment of chronic joint pain. This new research and similar papers indirectly and clearly suggests that Platelet Rich Plasma Therapy results will vary depending on the level of experience and training the doctor has in utilizing PRP.
This is alluded in the research: Platelet-rich plasma has been widely investigated and applied to regenerative medicine. PRP use is supported by evidence that PRP contains high concentrations of platelet-related growth factors and normal concentrations of plasma-derived fibrinogen, both of which contribute to the regenerative process. Additionally, its superior cost-efficacy versus conventional therapies is attractive to many clinicians. However, current disadvantages of PRP include a relatively complicated preparation procedure and doctor’s effectiveness in giving PRP treatment. 3
In new research (May 2015) doctors expressed concern over the lack of standardization among doctors using Platelet Rich Plasma Therapy. The researchers do acknowledge that the role of PRP in bone, tendon, cartilage, and ligament tissue regeneration has been shown in numerous preclinical studies published within the last 10 years to have delivered very promising results but many key questions remain unanswered and controversial results have arisen.
The same researchers also call for studies to define the dosing, timing, and frequency of PRP injections, different techniques for delivery and location of delivery, optimal physiologic conditions for injections, and the concomitant use of recombinant proteins, cytokines, additional growth factors, biological scaffolds, and stems cells to develop optimal treatment protocols that can effectively treat various musculoskeletal conditions.4
A recent article in Orthopedics Today warns against the high degree in variability among practitioners who use Platelet Rich Plasma (PRP). The main concerns are again those cited above – lack of standardization in treatment regimes and formula concentrations. Also mentioned are the various brands, concentrations, doses, etc that make it hard to determine the best use of PRP.5
What the researchers are calling for are protocols that are used at Caring Medical every day based on over 20 years experience in Prolotherapy and regenerative injection therapy and well documented in our own studies and clkinical applications.
Unfortunately, like many new and upcoming treatment modalities, there are good and not-so-good uses of the technique. Some physicians are rapidly jumping on the PRP bandwagon without having much injection experience or without any knowledge except for a weekend course in use of PRP. Prolotherapy is a specialized medical technique. It not only involves being able to choose the right proliferant for the patient’s particular pain complaint, but it also involves making a proper diagnosis, and then fully treating the injury. This is what we call Comprehensive Prolotherapy.
PRP Helps Bone Growth
Researchers at the University of Connecticut set out to discover how different Platelet Rich Plasma Therapy (PRP) methods effected human muscle, cell and bone tissue.6 They sought to recommend a standardized platelet concentration (the optimal amount of blood platelets reintroduced into the arthritic joint).
They found that PRP helps bone, muscle, and tendon cells proliferate no matter the cell concentration level. This proliferation leads to healing of damaged tissue and curing of chronic pain and injury.
PRP Helps with Osteochondral Lesions
Recently, the American Journal of Sports Medicine published an article on the use of PRP for osteochondral lesions.7 The results were great and the researchers concluded that, “in our hands, PRGF [platelet-rich growth factors, a form of PRP] has now become the first line of nonoperative treatment in these lesions.”
This study looked specifically at osteochondral lesions of the talus bone of the ankle. 29 patients age 18-60 participated in the study and they received either Hyaluronic Acid (HA) injections or PRP injections. While both HA and PRP decreased pain scores and increased function, PRP had significantly higher scores. Given that the traditional treatments of immobilization, bracing, and NSAIDs are often unsuccessful, the researchers were encouraged by these results, especially given that surgery is the only other option once conservative treatments fail.
In a third study, doctors found that following extraction of benign giant cell tumors and resulting large defects, that a PRP gel accelerated healing and growth of bone and achieved good functional results without promoting local recurrence.8
As PRP gains popularity, it is important to remember that PRP is just one proliferant available for the regenerative injection therapy that is Prolotherapy. A skilled Prolotherapist can use numerous proliferants depending on the severity of the pain or injury. Dextrose, PRP, and stem cells from bone marrow or adipose tissue all provide regenerative therapy that is effective and safe, leading to permanent healing of chronic pain and sports injury.
PRP Therapy for Knee Problems
There is a reason researchers are trying to find ways to regenerate cartilage. The reason is regenerative medicine is the future and the days of removing tissue is clearly limited. Recently doctors found that two PRP treatments with 4-week intervals, improved the pain, stiffness, and functional capacity of patients with knee osteoarthritis. Additionally Improvements in quality-of-life were meaningful after injections.9
Researchers at the University of Washington are the latest to join in on the discussion on the effectiveness of Platelet Rich Plasma Therapy for sports injuries. In their Platelet rich plasma therapy research review they noted that “Interest in platelet-rich plasma (PRP) has skyrocketed over the last decade. . . interest from the public has fueled increased utilization of PRP for musculoskeletal conditions, particularly those that are difficult to treat such as chronic, degenerative tendinopathy and osteoarthritis.”10
Please see research and clinical application of PRP for Knee Osteoarthritis, the page is frequently updated. If you already had a surgery and are having continued issues with joint pain, please see Platelet Rich Plasma Therapy after surgery. If you had meniscus surgery we have this article PRP after Meniscus surgery.
PRP Therapy for back pain
PRP and Shoulder Problems
Please see these updated articles on the use of Platelet Rich Plasma and stem cell therapy for Rotator Cuff and other shoulder problems. Another problem that can be addressed with PRP is Frozen shoulder, medically referred to as adhesive capsulitis. In this article we discuss PRP alternatives to surgery for glenoid labral tears.
Will Platelet rich plasma therapy work for me?
This question is subject of course to many factors, the least of which is getting Comprehensive Prolotherapy that includes Platelet Rich Plasma versus getting a single, or two-treatment program. The good news is that even in research where two PRP treatments are given, without supportive Prolotherapy, results were very positive. EVEN in patients who had continued Knee Pain after knee surgery. “PRP treatment showed positive effects in patients with knee osteoarthritis. Operated and non-operated patients showed significant improvement by means of diminishing pain and improved symptoms and quality of life.”11
Our paper on the Platelet Rich Plasma PRP Injection Technique printed in the Journal of Prolotherapy provides the basic information on PRP’s use as an effective proliferant for Prolotherapy treatments.
An experienced Prolotherapist can use PRP Prolotherapy in a safe and effective way to heal common joint injuries. One common issue occurring in the PRP field is that a number of practitioners are performing solely PRP, and not using dextrose Prolotherapy to address the underlying joint instability that most likely lead to the injury in the first place. Comprehensive Prolotherapy involves not only providing growth factors for healing and/or cartilage regrowth, but addressing the underlying cause of the problem. Our study on the use of PRP Prolotherapy for the treatment of meniscus tears published in Practical Pain Management discusses the comprehensive approach and shows how its use lead to surgery avoidance in an otherwise typically surgically corrected medical problem: mensicus tears.
As with any medical procedure, its success is determined by the experience, compassion, and technique of the practitioner providing the treatment. Platelet rich plasma used for injection is no different.
1. Marmotti A, Rossi R, Castoldi F, Roveda E, Michielon G, Peretti GM. PRP and Articular Cartilage: A Clinical Update. Biomed Res Int. 2015;2015:542502. Epub 2015 May 5.
2. Osterman C, McCarthy MB, Cote MP, Beitzel K, Bradley J, Polkowski G, Mazzocca AD. Platelet-Rich Plasma Increases Anti-inflammatory Markers in a Human Coculture Model for Osteoarthritis. Am J Sports Med. 2015 Jun;43(6):1474-84. doi: 10.1177/0363546515570463. Epub 2015 Feb 25.
3. Kawase T. Platelet-rich plasma and its derivatives as promising bioactive materials for regenerative medicine: basic principles and concepts underlying recent advances. Odontology. 2015 Jun 4. [Epub ahead of print]
4. Salamanna F, Veronesi F, Maglio M, Della Bella E, Sartori M, Fini M. New and Emerging Strategies in Platelet-Rich Plasma Application in Musculoskeletal Regenerative Procedures: General Overview on Still Open Questions and Outlook. Biomed Res Int. 2015;2015:846045. Epub 2015 May 5.
5. Mazzocca AD, et al. The Positive effects of different Platelet-Rich Plasma methods on human muscle, bone and tendon cells. Am J Sports Med August, 2012 40.8: 1742-1749.
6. Mei-Dan O, Carmont MR, Laver L, Mann G, Maffulli N, Nyska M. Platelet-Rich Plasma or Hyaluronate in the management of osteochondral lesions of the talus. Am J Sports Med 2012 40: 534.
7. Mattiello A, Cacciapuoti C. Autologous Platelet Gel Improves Bone Reconstruction of Large Defects in Patients with Bone Giant Cell Tumors. In Vivo. 2015 09-10;29(5):533-540.
8. “Platelet-rich plasma promises pain relief and healing, but remains controversial” Orthopedics Today. Web. April 2013. Accessed April 29 2013.
9. Dhillon RS, Schwarz EM, Maloney MD. Platelet-rich plasma therapy – future or trend? Arthritis Res Ther. 2012 Aug 8;14(4):219. [Epub ahead of print]
10. Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Platelet-rich plasma treatment in symptomatic patients with knee osteoarthritis: preliminary results in a group of active patients. Gobbi A, Karnatzikos G, Mahajan V, Malchira S. Sports Health. 2012 Mar;4(2):162-72.
11. Harmon KG, Rao AL. The use of platelet-rich plasma in the nonsurgical management of sports injuries: hype or hope? Hematology Am Soc Hematol Educ Program. 2013;2013:620-6. doi: 10.1182/asheducation-2013.1.620.