Platelet-rich-plasma therapy, also known as PRP therapy, aims to take advantage of the blood’s natural healing properties to repair damaged cartilage, tendons, ligaments, muscles or even bone.
A growing number of patients are turning to PRP injections to treat many orthopedic conditions including osteoarthritis, lateral and medial epicondylitis (tennis and golfer’s elbow respectively), rotator cuff and shoulder degeneration, plantar fasciitis, ligament tears, and sprains.
When treating orthopedic indications with PRP, a physician injects the platelet concentrate directly into the affected joint. The goal is to:
Platelet-rich plasma is derived from a patient’s own blood by placing the whole blood sample into a centrifuge which functions to separate out the platelets into a concentrate.
Plasma refers to the liquid component of blood; it contains red and white blood cells as well as other nutrients that travel through the blood stream including proteins, glucose and antibodies.
Platelets are another component of blood much like red and white cells. They secrete growth factors and many proteins that regulate cell division, stimulate tissue regeneration and promote healing.
The most common way to prepare PRP involves drawing a patient’s blood sample into a vial and centrifuging it at high speeds. The spinning causes the blood to separate into layers:
Red cells settle at the bottom of the vial and make up about 45% of the volume.
White cells and platelets form a thin layer in the middle called the “buffy coat” which makes up less than 1% of the centrifuged blood.
Platelet Poor Plasma (a low concentration) of platelets makes up the remaining top layer which comprises about 55% of the centrifuged sample.
Once the centrifuge process is finished, the doctor removes the vial from the centrifuge and prepares the PRP solution for injection.
The exact composition of PRP depends on the individual’s platelet level, the amount of blood drawn in the centrifugation process and whether or not additives were used. Some physicians combine additives with PRP such as thrombin and calcium chloride which can activate the platelets and may also boost the PRP’s regenerative properties.
Patients should be made aware that the use of PRP in conjunction with lifestyle changes and non-surgical options such as weight loss, physical therapy and use of NSAID’S may lead to a more favorable outcome.
Platelet-rich plasma injections are outpatient procedures. Because the patient’s blood must be drawn and prepared for injection, a typical procedure may take anywhere from 45 to 90 minutes.
The American Academy of Orthopaedic Surgeons recommends the following pre-injection guidelines:
Although the American Academy of Orthopaedic Surgeons published these pre-injection guidelines, the organization does not advocate for or against platelet-rich plasma treatment.
Patients are advised to take it easy for a few days and avoid putting strain on the affected area. The injection site may be swollen and painful for about 3 days, as the platelet-rich plasma typically stimulates a series of biological responses.
Doctors may recommend that the patient: