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Platelet-Rich Plasma (PRP) – OrthoInfo – AAOS

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.

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Platelet-Rich Plasma (PRP) - OrthoInfo - AAOS

What Are Platelet Rich Plasma (PRP) Injections?

Platelet rich plasma (abbreviated PRP) is a treatment used for a variety of common orthopedic conditions. PRP is a concentration of platelet cells taken from your blood, and these platelets have growth factors that may help in the healing process of chronic injuries. Growth factors are chemicals that signal the body to initiate a healing response. By injecting PRP into areas of an injury, the hope is to stimulate and optimize your body's ability to heal the chronic conditions. PRP contains a high concentration of platelets, other blood cells important in healing, and growth factors.

PRP has been used in operating rooms for several decades to help with wound healing, and to stimulate bone formation in spinal fusion surgery. Recently, PRP has been used in outpatient settings for treatment of common overuse conditions including:

PRP injections can be done in a physician's office. The procedure takes about 30 minutes in order to withdraw the blood, spin the blood in the centrifuge, and inject the PRP into the injured area.

Finding a physician who provides PRP injections can be a challenge, but most commonly these are offered by orthopedic physicians who specialize in the care of chronic sports injuries.

PRP is obtained from the patient who is being treated. Blood is withdrawn from a vein in the patient's arm and the blood is placed in a centrifuge, a machine that spins at a high speed to separate the different types of blood cells. The physician extracts the platelet-rich portion of the blood, and injects this into the area of injury. There is not just platelets in the concentrated layer of the "spun" blood, but also other important growth factors, plasma, and some red blood cells.

PRP injections are given as soon as the blood has been spun and the platelets separated. Some physicians may choose to add an "activating agent," usually either thrombin or calcium chloride, while some inject just the platelets. Studies have shown that the tendons being injected can also activate the PRP, so the activating agent may not be necessary.

There is no clear science to justify a particular quantity of PRP and number of injections needed. Most physicians perform one injection, although sometimes PRP injections are given as a series of injections over a span of several weeks.

We know from laboratory studies that PRP can help increase certain growth factors that are important in the healing process. What we do not know is if this makes any difference in healing when PRP is injected into an injured part of the body.

Clinical studies that have been done so far do not clearly demonstrate if PRP is more effective than other treatments. While there are reports of cases of success, it is not known if these successes are better, or worse, than other standard treatments. Currently, investigations are underway to determine if PRP is more helpful than other treatments for chronic tendonitis.

PRP has been shown to have some beneficial effects for tennis elbow, Achilles injuries, and even knee arthritis. Unfortunately, these are relatively small studies that follow the patients for a relatively short duration. Because of this, most doctors, and definitely most insurance companies, consider PRP to be experimental. However, talk to any patient who has found success with PRP, and they will tell you about how successful this treatment can be! It is important to remember, the even though there are some success stories and small studies that show benefit, we really don't know if PRP is worth the expense of this treatment.

Side effectsare uncommon, but they are possible. Whenever a needle is inserted through the skin, infection can occur. The other more common side effect of PRP injections is an increase in inflammation and pain after the injection.

PRP injections are not recommended in individuals with bleeding disorders, those taking anti-coagulation medications (e.g.Coumadin), or those who have cancer, active infections, or are pregnant.

PRP injections are not covered by most insurance plans, so there is usually a fee for providing this service. If your insurance does not cover these injections, you can try to appeal to the insurance provider, but because there is little scientific evidence to support PRP use, the likelihood of coverage may be low.

Most physicians charge between $500 and $1,000 per injection, although I have also heard of fees up to $2,500. Fees for PRP injections vary widely, and you may be able to work out a payment with your physician. While there are many different costs to obtain PRP, most physician offices use disposable kits offered by some of the major orthopedic supply companies. These kits cost a few hundred dollars, so there is certainly flexibility in payment, and you should negotiate the best possible rate if you are paying out of pocket.

PRP injections have been a subject ofsignificant interest for orthopedic surgeons and for their patients. Trying to stimulate a healing response within the body can be a challenge, and PRP injections may be an effective way to achieve that goal. While there is some data to support the use of PRP injections in certain clinical situations, there is other datathat questions whether this is more beneficial than traditional treatment. There is little harm in PRP injections, and they are certainly a reasonable option, but the cost of these injections is often not covered by insurance plans. I think it is reasonable to consider a PRP injection, however it certainly should not be viewed as a mandatory treatment, and this should only be consideredwhenother simpler,and more proven treatments are attempted first.

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What Are Platelet Rich Plasma (PRP) Injections?