Platelet Rich Plasma (PRP)

WHAT IS REGENERATIVE ORTHOPAEDIC TREATMENT?

From traumatic injuries to sports activities to repetitive day-to-day life duties, we put our bodies through a lot of wear and tear. The joints, tendons, and cartilage in the major joints of our extremities absorb the bulk of this stress, and unfortunately, these tissues have limited ability to heal on their own. Several conditions can cause pain, such as traumatic injury, repetitive overuse, or degenerative arthritis.

Regenerative Orthopaedic treatments are a non-surgical, natural treatment option using the healing power of your own cells regenerative and reparative potential to accelerate healing, repair damaged tissues, improve range of motion, and address pain.

WHAT IS PRP?

Platelet Rich Plasma therapy is a regenerative orthobiologic treatment, meaning the treatment harnesses the healing power of your own body to overcome your joint injury or pain. PRP contains platelets, specialized compounds in your blood that contain growth factors that help stimulate and recruit regenerative healing cells to the area in which they are introduced. The concentrated platelets found in PRP contain tremendous reservoirs of bioactive proteins, including growth factors and signaling proteins that are vital to initiate and accelerate tissue repair and regeneration. There are hundreds of different growth factors present in the concentrate. These bioactive proteins initiate connective tissue healing in tissues such as meniscus (knee), labrum (hip/shoulder), rotator cuff tendon. These factors also improve bone healing, articular cartilage regeneration, promote development of new blood vessels (angiogenesis), and stimulate the wound healing process.

Platelet Rich Plasma therapy is a treatment option for various Orthopaedic injuries and conditions, which have traditionally required surgery or other extensive treatments. PRP injections are being utilized in Orthopaedics with increasing frequency and effectiveness. Injuries currently being treated with the PRP therapy are arthritis of the hip, knee, shoulder, ankle and other joints. PRP also is utilized for soft tissue injuries such as tendonitis, muscle sprains and tears, and various types of ligament injuries. These include common tendon injuries such as tennis and golfers’ elbow, Achilles tendonitis and knee tendonitis. PRP is also used to treat various injuries and conditions affecting (joint) injuries.

Once prepared, the PRP injections are sometimes performed under ultrasound guidance, fluoroscopic guidance, or under direct visualization via needle arthroscopy. This is done for precise localized delivery of PRP into injured ligaments, muscles, and joints. PRP signals macrophages to debride the damaged tissue and fibroblasts to provide collagen to repair the tissue and angiogenesis to occur. The PRP graft also stimulates pericytes, stem cells that live on the walls of local blood vessels, to become activated and repair the area of injury. The PRP stem cell interaction is crucial to the healing process.

We use several different types of PRP systems from Regenlab and Emcyte to ensure the highest concentrations of platelets and other effective growth factors to maximize the healing potential of the PRP aspirate for your specific injury. The PRP systems vary in the speed of the centrifuge, the angle of tube while spinning, presence or absence of monocytes and lymphocyte white blood cells. Monocytes and lymphocytes also has beneficial regenerative effects but are not necessarily indicated for the treatment of all conditions. Dr. Wilkerson will determine and recommend which option will be best to treat your specific condition.

WHAT RESULTS TO EXPECT:

•Reduced joint pain

•Improved range of motion

•Better mobility

•Less reliance on over-the-counter or prescription medication

•Reduced inflammation

The human body has a remarkable ability to heal itself, and by re-injecting concentrated platelets, we are facilitating the natural healing process. The PRP injections are calling in stem cells to repair the area. When performing these injections, we must do whatever we can to maximize stem cell release to optimize healing. We know certain factors diminish stem cell release such as smoking and alcohol intake. Obviously avoiding these pitfalls will do nothing but increase the success of the procedure. The platelets work by releasing growth factors which attract and activate stem cells.

These regenerative treatments may allow you to delay the need for surgery or decrease the need for medication. The number of PRP injections performed depends upon the severity and the type of condition being treated. Age also seems to have an effect on the number of injections given; younger people generally need fewer injections for the same condition than older people. After the PRP injection is given, there is usually a mild increase in pain for anywhere from 3-10 days. Tylenol will usually handle this pain.

HOW LONG WILL RESULTS LAST?

PRP does not offer instant pain relief, but regenerates injured or damaged tissue over time. This takes a few weeks. Clinical studies show that the effects of PRP injections last anywhere from nine months to several years. This depends on the area injected, the severity of the pain or injury, and the concentration or dosage of PRP. Depending on your situation, we may recommend a series of injections or combine PRP treatments with other modalities, including physical therapy or BMAC (Bone Marrow Aspirate Concentrate), to prolong results.

PRP FOR JOINT PAIN OR INJURY COST & PRICING STRUCTURE

PRP injection therapy is priced based on the amount of PRP needed, the area treated, and the type of injury treated. Sometimes, a series of PRP injections are recommended. Dr. Wilkerson or one of our regenerative medicine experts at will determine the specifics at your personalized consultation.

BEFORE & PREPARATION

•Initially, you will see one of our regenerative medicine providers to determine if you are an appropriate candidate for the procedure.

•We may perform or order diagnostic tests (radiographs, MRI scan, or ultrasound) to determine your eligibility for treatment.

•Please bring any existing diagnostic imaging reports and images to your appointment.

•Avoid all anti-inflammatory medications like Aleve, Motrin, Advil, and cortisone seven days before treatment.

•Notify your provider if you take any blood thinners.

•Eat a light meal one to two hours before treatment.

•Drink 6-8 glasses of water the day before and on the day of treatment.

•Avoid smoking five to seven days before and after treatment. Smoking will impair your healing process.

AFTERCARE & RECOVERY

•Regenerative PRP injections are designed to produce an immediate inflammatory response to initiate the healing cascade of in the treatment area. Local anesthetic is injected or applied topically prior to injecting the platelet graft to neutralize any discomfort.

•It is common to experience stiffness, soreness, swelling, or slight pain, which decreases in intensity over time.

•Avoid anti-inflammatory medications or anti-inflammatory supplements for a minimum of 6 weeks following treatment.

•Avoid steroid medications.

•Do not apply ice to the treatment area. Ice decreases inflammation, which slows the healing process.

•Keep the treatment area as still as possible for 30-60 minutes post-injection.

•You may shower following treatment.

TREATMENT AREAS

Common treatment areas include:

• Rotator cuff
• Biceps
• Tennis elbow
• Achilles tendon
• Plantar fasciitis
• Hip osteoarthritis
• Knee osteoarthritis
• Shoulder osteoarthritis

PRP therapy may be a suitable option for those with joint pain or injury:

• Who does not respond to standard treatment
• Want to reduce their dependence on medication
• Who desire natural or alternative treatment options
• Suffer from pain or injury in their ligaments, tendons, cartilage, or muscle

Contraindications

The following are contraindications for PRP therapy:

• Active infection
• Active cancer
• Platelet disorders
• Anticoagulant therapy
• Bleeding Disorders

Related Procedures

Hyaluronic Acid Injection

•Hyaluronic acid (HA) is a naturally occurring substance found in the synovial fluid surrounding joints.

•Acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads.

•Patients with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints.

•Adding hyaluronic acid to the arthritic joint will facilitate movement and reduce pain.

•Hyaluronic acid was first used in Europe and Asia, and was approved by the U.S. Food and Drug Administration in 1997.

Outcomes of Hyaluronic Acid Injection
• Some patients will not be helped by visco-supplementation
• May take several weeks to notice an improvement.
• How long the effects last varies. HA effectiveness typically last 6 months to 1 year
• Treatment can be repeated every 6 months.
• Hyaluronic Acid alone has never been shown to reverse the arthritic process or re-grow cartilage.
• Most effective for osteoarthritis in its early stages (mild to moderate).

Benefits of Combining Hyaluronic Acid with PRP Therapy

• Increases cell resistance to anti-oxidative stress thereby reducing loss of chondrocytes and mesenchymal stem cells (MSCs) (Miki et al., 2010; Sánchez et al., 2016).
• Reduces the production of extra cellular matrix (ECM) degrading enzymes such as matrix metalloproteinases (Satin et al., 2019; Sundman et al., 2014; Wang et al., 2015; Yang et al., 2016).
• Combination of PRP and HA has an additive effect and reduced expression of enzymes that contribute to the breakdown of the cartilage ECM (Satin et al., 2019).
• Generates a temporary fibrin scaffold at the injection site that attracts cells needed for the regeneration process.
• Combination of PRP and HA may result in a more stable scaffold that allows the controlled or enhanced release of growth factors into the surrounding milieu, as well as binding extracellular matrix proteins such as fibronectin, and the migration of cells needed for cartilage repair (Andia and Abate, 2014; Lio et al., 2016; Martino et al., 2013).
• Increase production of proteins needed for cartilage repair, such as proteoglycan, collagen type II, and aggrecan, which is a key component of the articular ECM as it provides cartilage with its load bearing properties (Satin et al., 2019[…]”

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