All about Platelet Rich Plasma
By
Robert Rinaldi, DPM
Posted January 27th, 2009
Platelet Rich Plasma (PRP) has been used in hospital settings since the 1970s, though its application was restricted mostly to surgery. Recently, advanced technology has brought this unique, helpful, safe treatment to sports medicine clinics around the world.
PRP DEFINED
Concentrated platelets and white blood cells derived from a patient’s own blood are spun in a closed autologous platelet separator, producing a material that can be injected back into injured tissue. This causes the body to create what has been called a “repair response” within the injured tissue. The repair response in muscle, tendon, ligament, and bone starts with the formation of a local blood clot, and the dissolving or degranulation of the implanted platelets. In this microscopic environment, growth factors are released, fibrous scar tissue is formed, and injured tissue is replaced with healthy tissue.
PREPARING PRP
A health provider takes a small amount of blood from you and places it in a Platelet Separator System. This is a highly specialized centrifuge that separates and then concentrates your body’s own platelets, white blood cells, and growth factors, the ingredients in platelet rich plasma. The PRP is then mixed with activating agents so that your provider can inject it into injured tissues. The process is completely safe since the substances used are derived from your own body. There is no chance of adverse drug reactions that sometimes result from other medicinal materials. There are many PRP systems being used today, but the best are completely closed systems. This essentially means that the system will not allow any other product or material to enter during the entire process of producing the PRP. The best systems are completely automatic, allowing for consistent reproducible concentrates of PRP.
PRP AND SPORTS MEDICINE
PRP research is ongoing and data is being collected daily. The criteria for using PRP is usually established when other more conservative treatment programs have failed. PRP has moved to surgical procedures that include knee, hip, and spine surgery. The repair response has also been found effective in shoulder and ACL reconstructions. The healing of chronic wounds has been enhanced with the use of PRP, however, it is soft tissue structures—tendons, muscles, and ligaments—that have been treated with PRP for the longest, and this is the area where the greatest research has been completed.
Sports medicine providers have found PRP to be most useful for treating chronic injury to soft tissue structures in the arms and legs. Injuries that have consistently shown favorable results are Achilles tendonitis, plantar fascitis, tennis elbow, and bicep tendonitis. Generally, tendon injuries in the foot, leg, arm, and hand respond well to treatment programs. Treatment is not for everyone and though it seems magical not all injury responds to treatment. Successful outcomes in the sports medicine arena are around 85 percent.
A TYPICAL TREATMENT SESSION
First, your health provider must determine that more conservative treatments for your injury have failed and that you are a candidate for PRP. Then you schedule an appointment for the PRP procedure. Most providers require that a release similar to a surgical release be signed. There is no need for any pre-op or blood testing type preparations that usually include fasting from the night before.
The entire process should take about an hour and include a venipuncture and blood draw. In most instances about 60 cc of blood are drawn from a vein in your arm, using a special syringe that is taken directly to the PRP centrifuge equipment. The spin-down takes about 20 minutes, and it is fascinating. (Ask to see the process in progress.) Once the separator has completed its task, the PRP is automatically moved from the large syringe to a smaller syringe. Then the injection process into the injured site begins.
The injured site will be examined one last time, and a small amount of local anesthesia is often used within the site to minimize the discomfort of injecting the PRP. The site will be prepped with an antiseptic wash and the process begins. Complicated areas will require the use of Ultra Sound Imaging to exact the deposition of the PRP directly into the injured tissue. Once the injection begins it will take only a few painless moments, and it is over. There may be some tenderness at the site after the local anesthesia is worn off. Acetaminophen is usually recommended to cover this minimal discomfort. The process is completed in about an hour and for the most part is painless.
SUMMARY
I have had the opportunity to use PRP treatment programs at the clinic where I work, and I have to say it seems miraculous. I have also read reports of success by other doctors who have treated difficult fractures and repaired complicated tendon injuries using PRP, and I believe that medical providers will soon be turning to PRP treatment programs as a first plan for treating athletic injuries. At this time, however, many medical insurance policies do not cover the expense of PRP. From a medical-legal perspective, PRP should be used when a patient fails to respond to more conservative treatments. I expect that time will provide additional statistics of success, and this will demonstrate that the cost and associated risk of PRP treatment are actually a frugal, safe, and effective way of treating athletic injuries. You should ask your treating provider about platelet rich plasma. If you feel that I may help with answers to your questions, please do not hesitate to contact me.
Robert Rinaldi is a board-certified podiatrist and podiatric surgeon at the Gifford Medical Center in Randolph, VT. He is a fellow and a founding member of the American Academy of Podiatric Sports Medicine, and a podiatric consultant to the Dartmouth College track and cross-country teams. He is a former nationally ranked long-distance runner, having competed in 25 world-class marathons.
You can reach him at Gifford Sports Medicine and Surgery Clinics in Randolph, VT, or at the Sharon Health Clinic in Sharon, VT, 802-728-2490 or 802-763-8000 or at rrinaldi@giffordmed.org.