Initially in Europe, and more recently in the United States, there has been an increasing interest in the use of patient’s own blood products to stimulate healing in a variety of settings. During the past several years, much has been written about one preparation called platelet-rich plasma (PRP) and its potential effectiveness in the treatment of various acute injuries and chronic conditions.
Several years ago, PRP injections got their first big publicity boost when two of the Pittsburgh Steelers’ stars, Hines Ward and Troy Palamalu, were treated with PRP before they returned from injuries to win the Super Bowl. Since then, many famous athletes — Tiger Woods, Rafael Nadal and others — have received PRP for various problems, such as sprained knees and chronic tendon injuries. Traditionally, 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.
Experts agree that PRP injections may be the key to treating a variety of stubborn injuries, such as tennis elbow, tendonitis in a variety of locations and plantar fasciitis. In addition, PRP injections have frequently been used in the treatment of osteoarthritis of the knee and other joints. Presently, we have learned more about the role of growth factors in the healing process. There is a growing enthusiasm for the use of concentrated platelets, which contain dense concentrations of growth factors to stimulate recovery for non-healing injuries. Even though PRP has received extensive publicity, there are still lingering questions about it, such as what exactly is platelet-rich plasma; how does it work; what conditions are being treated with PRP; and is PRP treatment effective?
Here are the answers to these questions, as well as some of the most common questions I am asked in my office regarding PRP treatment:
1. What is PRP?
Platelets are special types of blood cells that promote blood clotting and injury healing. Exciting research demonstrates that when a concentrated platelet solution, known as PRP, is injected into an injury it can stimulate healing. 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 five to 10 times greater (or richer) than usual.
To develop a PRP preparation for injection, 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, where the blood is spun at very high speeds for between five and 15 minutes. Then the increased concentration of platelets is combined with the remaining blood.
2. Why does PRP work?
Human platelets are extremely rich in important protein products, connective tissue growth factors and other enzymes that play important roles in the healing and regenerative processes. Injecting these growth factors into damaged ligaments, tendons and joints stimulates the natural repair process. The key to obtaining benefit from injecting these natural healing proteins is that the platelets must be concentrated. In other words, by delivering a high concentration of platelets into a soft tissue injury, PRP recreates and stimulates the body’s natural healing process. Simply put, PRP jumpstarts the body’s own ability to heal itself.
3. What conditions can benefit from treatment with PRP?
PRP treatment works best for chronic ligament and tendon sprains or strains that have not recovered with other conservative treatment. These injuries include rotator cuff injuries; tennis elbow; golfer’s elbow; hamstring injuries; knee ligament sprains; patella tendonitis; ankle sprains; Achilles tendonitis and partial tears; plantar fasciitis; and osteoarthritis.
4. How is PRP done?
In the office, one syringe of blood is drawn from the patient and placed in a special centrifuge where it is spun at high speed. By doing this, the platelets are separated from the red blood cells and other blood products. In addition, they are highly concentrated, thereby multiplying the healing strength of the platelets, growth factors and enzymes. The injured area is anesthetized and then injected with this high concentration of platelets. By injecting concentrated platelets and their growth factor directly into an injured area, the bodies own healing and regeneration processes are strongly stimulated to start and assisted in their effect.
5. How many injections are needed?
Many patients respond after the first treatment. A follow up appointment is scheduled six to eight weeks after the injection to evaluate the patient’s progress. In some patients, up to three sessions are necessary. There’s no set number of injections in a course of therapy, although several doctors who have published articles on the topic recommend one to three injections, with four weeks between injections.
6. Do PRP injections hurt?
The injured area is first anesthetized with long and short acting medications, so the actual injections are only slightly uncomfortable. Once the numbness wears off, there may be some mild increase in pain for several days. Patients are instructed to avoid nonsteroidal anti-inflammatory drugs (NSAIDs), such as Advil, Motrin, Aleve, Celebrex and others, since they will neutralize the healing response that is stimulated by the PRP. Tylenol is OK.
7. Are there risks associated with PRP?
Of course, any time there is an injection, there are risks of infection, bleeding or even nerve damage. However, all of these are extremely rare. Since we are injecting the patient’s own blood back into the injury, the risks of any allergy or sensitivity doesn’t exist.
8. What is the success rate for PRP injections?
Most recent studies suggest a significant success rate for PRP therapy. 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 the area of the body being treated; the overall health of the patient; and whether the injury is acute (such as from a fall) or chronic (an injury developing over time).
Some patients experience partial improvement, and many patients have complete relief. Since PRP stimulates healing and is not a “cover up,” results are generally permanent.
In summary, PRP now provides a promising alternative for the treatment of a variety of injuries and chronic conditions. It is safe, easy to perform and promotes a natural healing response for patients. Treatment with PRP is very promising and exciting, however, current research studies to back up the claims in the media is still inconclusive. Even though the success of PRP therapy is still being studied, 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 and/or nerve injuries – appears to be no different than those associated with cortisone injections.
By Dr. Michael Gross
Dr. Michael Gross is the founder and director of Active Orthopedic and Sports Medicine. He is the orthopedic director for Sports Medicine at Hackensack Meridian Medical Center and an assistant professor at Hackensack Meridian School of Medicine at Seton Hall. Dr. Gross has written numerous articles and book chapters on sports injuries. He has taken care of some of Bergen County’s finest athletes, from weekend warriors to professional athletes. Dr. Gross can be reached by email at email@example.com.