Overview of PRP
Of all the orthobiologic treatments, PRP has turned out to be the early star in the sports medicine world. It is affordable, low-risk, and effective. Platelet Rich Plasma (PRP) is derived from one’s own blood, and contains a supraphysiologic concentration of platelets, healing enzymes, and growth factors. Although platelets are usually thought of in the context of the clotting process of blood, PRP contains many biologic elements which are crucial to healing (VEGF, FGF, IGF, PDGF, and TGF). In general, tendons and other soft tissues have a poor blood supply, and this can limit their ability to heal. An injection of concentrated PRP can provide healing growth factors to the injured area (imagine one month’s worth of healing nutrients in a single injection).
Although the exact concentrations of these growth factors varies among different preparations of PRP, it is known that the growth factors as well as interleukins and cytokines found in PRP are important in cell proliferation, healing, differentiation, neovascularization (blood vessel growth), and signaling. These substances are important in maintaining the health of cartilage within a joint, new blood vessel formation after injury, and to recruit stem cells and fibroblasts to the injury site. PRP is produced from a patient’s own blood, so the risks are minimal, and the procedure can be performed in the office. Blood is collected through a peripheral blood draw, and the procedure requires only a small amount to be drawn. The patient’s blood is then manipulated through a proprietary set of syringes and a centrifuge to separate the blood into distinct layers. Filters can be used to further concentrate the PRP. The layer containing the PRP is then isolated and prepared for injection at the injury site.
Conditions Effectively Treated by PRP
PRP can be used to treat many different musculoskeletal conditions. Research studies have shown its effectiveness in chronic tendon injuries, acute muscle, ligament, and tendon injuries, and knee arthritis. Examples include:
- Achilles tendinosis/tendonitis
- Patellar tendonosis/tendonitis (Jumper’s knee)
- Plantar fasciitis (Runner’s foot)
- Lateral epicondylitis (Tennis elbow)
- Medial epicondylitis (Golf elbow)
- Turf toe
- Knee osteoarthritis
- Shoulder injuries (including rotator cuff tears)
PRP Injection Process
The first step is to schedule an appointment with a sports medicine doctor who utilizes biologic and restorative therapies. A thorough patient history, physical examination, and imaging review will determine if you could benefit from PRP therapy. The actual PRP treatment can be done in clinic. A small amount of blood is collected through a routine blood draw, and the PRP is prepared while you wait. The injured area is injected directly, in some cases using ultrasound imaging guidance. The area might be sore for several days after the injection, and it may take several weeks to notice a healing effect. In some cases, a series of injections over a few weeks are needed to deliver the appropriate amount of PRP. After the injection your physician may modify your activities and prescribe physical therapy. Since PRP is an emerging technology, commercial health insurance plans typically do not cover PRP treatments. However, the costs are modest compared to similar treatment options.
- 21 Pro Athletes Who Benefited from PRP Treatment.
- American Academy of Orthopaedic Surgeons (AAOS) Patient Information Page on PRP.
- USADA – Orthobiologics: What do Athletes Need to Know about PRP?
- Musahl V, Murphy C, Pfeiffer TP, Burnham JM, Gasbarro G. Current State for Clinical Use of Stem Cells and Platelet-Rich Plasma. Bio-orthopaedics: A New Approach. 2017.
- Martinelli N, Marinozzi A, Carnì S, Trovato U, Bianchi A, Denaro V. Platelet-rich plasma injections for chronic plantar fasciitis. International Orthopaedics. 2013;37(5):839-842. doi:10.1007/s00264-012-1741-0.
- Jain K, Murphy PN, Clough TM. Platelet rich plasma versus corticosteroid injection for plantar fasciitis: A comparative study. Foot (Edinb). 2015 Dec;25(4):235-7. doi: 10.1016/j.foot.2015.08.006. Epub 2015 Aug 22. PubMed PMID: 26362235.