What is plasma and what are platelets?
Plasma is the liquid portion of whole blood. It is composed largely of water and proteins, and it provides a medium for red blood cells, white blood cells and platelets to circulate through the body.
Platelets, also called thrombocytes, are blood cells that cause blood clots and other necessary growth healing functions.
Platelet activation plays a key role in the body’s natural healing process.
What is platelet-rich plasma (PRP) and what are PRP injections?
Platelet-rich plasma (PRP) therapy uses injections of a concentration of a patient’s own platelets to accelerate the healing of injured tendons, ligaments, muscles and joints. In this way, PRP injections use each individual patient’s own healing system to improve musculoskeletal problems.
PRP injections are prepared by taking anywhere from one to a few tubes of your own blood and running it through a centrifuge to concentrate the platelets.
These activated platelets are then injected directly into your injured or diseased body tissue.
This releases growth factors that stimulate and increase the number of reparative cells your body produces.
Knee pain, Osteoarthritis, Arthritis
Researchers studying PRP and osteoarthritis often work with patients who have knee osteoarthritis, a condition that experts estimate will affect nearly half of all Americans at some point during their lives.
Two clinical studies that examine PRP to treat knee arthritis are described below.
- One study, published in 2013, involved 78 patients with osteoarthritis in both knees (156 knees). Each knee received one of three treatments: 1 PRP injection, 2 PRP injections, or 1 placebo saline injection. Researchers evaluated the subjects’ knees 6 weeks, 3 months, and 6 months after injection. Researchers found:
- Knees treated with 1 or 2 PRP injections saw a reduction in pain and stiffness as well as improvement in knee function at 6 weeks and 3 months.
- At the 6-month mark positive results declined, though pain and function were still better than before PRP treatment.
- The group that received placebo injections saw a small increase in pain and stiffness and a decrease in knee function.
The platelet-rich plasma used in this clinical study had 3 times the platelet concentration of normal blood and had been filtered to remove white blood cells.
- A second, smaller study examined patients who had experienced mild knee pain for an average of 14 months. Each arthritic knee underwent an MRI to evaluate joint damage and then received a single PRP injection. Patients’ knees were assessed at the 1 week, 3 month, 6 month and 1 year marks. In addition, each knee underwent a second MRI after one year. Researchers found:
- One year after receiving a PRP injection, most patients had less pain than they did the year before (though pain had not necessarily disappeared).
- MRIs showed that that the degenerative process had not progressed in the majority of knees.
While knee cartilage did not seem to regenerate for patients, the fact that the arthritis did not worsen may be significant. Evidence suggests that an average of 4 to 6% of cartilage disappears each year in arthritic joints.
Patellar Tendinopathy
Patellar tendinopathy (PT) is a common source of pain and dysfunction in both high-demand and recreational athletes. It can be a difficult condition to treat, and uniform consensus on the optimal treatment strategy is currently lacking.
Accordingly, platelet-rich plasma (PRP) has emerged as a treatment option for tendinosis that may improve the healing process and speed recovery.
It is becoming increasingly evident that PRP comprises a cocktail of growth factors and cellular components that synergize to contribute to its established anabolic effects.
However, some PRP formulations also contain various inflammatory mediators that may adversely affect tendon healing.
Although PRP is one of the most thoroughly studied biologics in orthopaedic applications, its role in the treatment of PT remains unclear.
Though PRP may be considered for the treatment of recalcitrant PT, current consensus on its use is still inconclusive and outcomes are unpredictable.
This evidence-based article summarizes the current understanding of PRP’s biological activity, clinical efficacy, and how it may be most effectively used to treat PT.
Foot pain , Plantar Fasciitis
A study published in 2017 examined the evidence for using PRP for plantar fasciitis. The researchers found that PRP works better than steroid injections to ease the pain associated with plantar fasciitis.
Another study compared participants with plantar fasciitis who received traditional, conservative treatment with a group that received PRP. At six-month and 12-month follow-ups, the patients who had received PRP were still largely pain-free, while many in the conservative treatment group were back to their baseline level of pain.
There are few risks associated with PRP. Because the therapy involves your own blood, there’s no chance that you’ll have an allergic reaction to it. The only risk, and it’s less than 1%, is that you may have an infection at the injection site.
About 80% of people who have plantar fasciitis recover with conservative treatment. However, if you’re one of those who has experienced chronic pain due to plantar fasciitis, you may have additional questions about PRP.
Shoulder pain , Rotator Cuff Tendinopathy
PRP has shown potential for its use in the non-surgical management of various shoulder pathologies.
A growing body of literature exists regarding the use of PRP in treating rotator cuff tears; however, there remains great variation in PRP preparations and methods of administration, limiting the collective conclusion of these studies.
For select patients with rotator cuff tears, non-surgical measures such as strengthening exercises, NSAIDs, and corticosteroid injections may effectively address clinical symptoms and functional deficits.
The proposed role of PRP in the non-operative treatment of rotator cuff tears is to decrease pain and inflammation and potentially to stimulate healing, providing a viable alternative to surgery. Specifically, PRP has been studied as an alternative to corticosteroid injection.
Tennis Elbow, Carpal tunle Syndrome
PRP for tennis elbow has been proven to be more effective in helping patients with the pain and discomfort.
That’s because the PRP serum contains a concentration of growth factors, mesenchymal stem cells, cytokines, chemokines, platelets, and various other healing elements.
The different types of growth factors contain compounds that stimulate the creation of new collagen which forms the basis of tissues.
In addition, PRP develops new blood vessels in the torn tendons so they receive a fresh supply of nutrients that assist in their repair.
While most other treatment options simply work to relieve the pain, PRP acts to repair the tissues for long-term relief.
In case your discomfort is related to Carpal Tunnel Syndrome, you can opt for PRP for wrist pain to eliminate the inflammation and restore mobility.
Sports injuries and Ankle Sprains
Platelet-rich plasma (PRP) injections offer a highly effective third alternative for many common sports and other injuries. PRP injections are minimally invasive, safe, and quick. Instead of being sidelined for long stretches, athletes (and non-athletes) can now benefit from PRP treatment’s faster recovery times
Doctors have been treating joint injuries with PRP therapy for many years. Platelet-rich plasma is a concentrated serum that is made from your very own blood, and it can be used to trigger your body’s healing response.
To make PRP, we will place a small sample of your blood in a medical device known as a centrifuge.
That machine spins the blood at a very high speed in order to separate all of the different molecules.
Once we have separated the platelet-rich plasma from the other cells, we can inject the serum into your PRP ankle injections are incredibly effective for most patients, but you will need to consider all of your treatment options before any procedure is carried out ankle.
Your body should naturally repair the ligaments even if you don’t undergo PRP therapy, but that recovery period could take weeks. The average ankle sprain may take a few months to heal.
With PRP therapy, we can cut the recovery time down to a few weeks. At that point, you can begin the process of strengthening the nearby stabilizer muscles that support your ankle.
Hip Osteoarthritis
Osteoarthritis is a significant cause of chronic pain in the elderly population with hip osteoarthritis as one of the main causes of functional disability and joint pain in adults older than 55 years.
Recently, platelet rich plasma (PRP) injections have been introduced for treatment of osteoarthritis.
The aim of this systematic review is to assess its effectiveness in the management of hip osteoarthritis.
We performed a search of the literature for published prospective studies that assessed the effectiveness of PRP injections in the treatment of hip osteoarthritis, with a minimum follow-up of 3 months. Primary outcome measures were WOMAC and VAS scores.
Five trials were identified with 185 patients undergoing treatment with ultrasound-guided intra-articular injections of PRP, compared with patients treated with hyaluronic acid alone (n = 148) or hyaluronic acid combined with PRP (n = 31) in one study.
PRP was shown to improve patient outcome scores at follow-up at 6 and 12 months; however, there was no significant difference seen between patients treated with PRP or hyaluronic acid alone.
Following this systematic review, we cannot currently recommend the use of intra-articular injections of PRP for the treatment of hip OA.
Given that intra-articular steroid injections are the only such injection recommended by international guidelines for the treatment of hip OA, further studies comparing PRP to steroid would be of benefit to determine the value of PRP injections in hip OA.
Greater Trochanteric Pain Syndrome
This review aims to determine whether platelet-rich plasma (PRP) has any role in improving clinical outcomes in patients with symptomatic greater trochanteric pain syndrome (GTPS).
A search of NICE healthcare database advanced search (HDAS) via Athens (PubMed, MEDLINE, CINAHL, EMBASE and AMED databases) was conducted from their year of inception to April 2018 with the keywords: ‘greater trochanteric pain syndrome’ or ‘GTPS’ or ‘gluteus medius’ or ‘trochanteric bursitis’ and ‘platelet rich plasma’ (PRP).
A quality assessment was performed using the JADAD score for RCTs and MINORS for non-RCT studies. Five full-text articles were included for analysis consisting of three RCTs and two case series.
We also identified four additional studies from published conference abstracts (one RCT and three case series). The mean age in 209 patients was 58.4 years (range 48–76.2 years).
The majority of patients were females and the minimum duration of symptoms was three months. Diagnosis was made using ultrasound or MRI.
Included studies used a variety of outcome measures. Improvement was observed during the first 3 months after injection. Significant improvement was also noted when patients were followed up till 12 months post treatment.
PRP seems a viable alternative injectable option for GTPS refractory to conservative measures. The current literature has revealed that PRP is relatively safe and can be effective.
Considering the limitations in these studies, more large-sample and high-quality randomized clinical trials are required in the future to provide further evidence of the efficacy for PRP as a treatment in GTPS.
Gluteal Tendinopathy
Gluteal tendinopathy is the most common injury that involves the tendons in the hips. The gluteal tendons are those that connect your glute muscles to the hip bones.
These tendons can develop several micro-tears over time, leading to inflammation, pain with movement, and more.
Tendon injuries can be difficult to heal, and oftentimes hip tendonitis is addressed using cortisone steroid injections.
However, these injections are not always effective and can have side effects. On the other hand, platelet-rich plasma, or PRP, therapy provides a safer and more effective treatment option to repair the damaged tendon, eliminating the source of the pain and restoring function to your hips.