Platelet Rich Plasma (PRP)
PRP has been used in medicine for many years to treat conditions in several different specialties including Urology, Dermatology, Plastic Surgery, Neurosurgery and Orthopedic Surgery. Within Orthopedics, PRP has been mostly successful at treating soft tissue conditions involving tendons, ligaments, and muscles, but is starting to find more favor in the treatment of early stages of arthritis.
PRP is a concentrate of plasma protein derived from whole blood. Our current understanding of PRP’s mechanism of action on the healing process is still developing. Platelets contain granules which carry an abundance of growth factors and other cytokines that are strong promoters of the healing response.
In my patients, common conditions where I have found great success with PRP is partial rotator cuff tears, labral tears in the shoulder, weight lifters shoulder (distal clavicle osteolysis), lateral and medial epicondylitis (tennis/golfers elbow), partial UCL tears in the elbow, and ligament tears in the wrist (SL ligament and TFCC injuries), to name a few. Steroid injections used to be used much more commonly for these conditions. But as we learn more about the limited long term benefits of steroids combined with the deleterious effects of steroids on tissue healing, alternative options such as PRP have become much more popular and appropriate.
PRP injections are performed in the office and the entire process takes less than 15 minutes. After a simple blood draw, the sample of whole blood is placed into a centrifuge. The plasma layer containing the now concentrated platelets is removed and then injected into the area of concern. Following the injection, standard protocols call for avoiding NSAID (anti-inflammatory) medication as well as vigorous use of the injected body part for 3 weeks. On average, we see significant improvement in 6 - 8 weeks in over 80% of the patients. In my practice, one concentrated PRP injection is typically all that is necessary to achieve the desired result. Occasionally, a 2nd PRP injection may be considered if enough improvement does not occur after the first injection.
Unfortunately at this time, even though there is a plethora of data demonstrating the efficacy of PRP as a safe and reliable treatment option for many Orthopedic conditions, insurance carriers do not cover the cost of this treatment. If you are interested in learning more about PRP and whether or not it may be beneficial for your condition, feel free to contact us.
PRP References:
Efficacy of platelet rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients
Mishra AK, Skrepnik NV, Edwards SG, Jones GL, Sampson S, Vermillion DA, Ramsey ML, Karli DC, Rettig AC. Am J Sports Med. 2014 Feb;42(2):463-71.
Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials
Krogh TP, Bartels EM, Ellingsen T, Stengaar-Pedersen K, Buchbidner R, Fredberg U, Bliddal H, Christensen R. Am J Sports Med. 2013 Jun;41(6):1435-46.
Treatment of partial ulnar collateral ligament tears in the elbow with platelet rich plasma
Podesta L, Crow SA, Volkmer D, Bert T, Yocum LA. Am J Sports Med. 2013 Jul;41(7):1689-1694
Platelet Rich Plasma Can Be Used To Successfully Treat Elbow Ulnar Collateral Ligament Insufficiency In High Level Throwers
Dines JS, Williams PN, ElAttrache N, Conte S, Tomcyzk T, Osbahr DC, Dines DM, Bradley J, Ahmad CS. Am J Orthop. 2016 Jul-Aug;(45), 296-300.
Platelet Rich Plasma for Primary Treatment of Partial Ulnar Collateral Ligament Tears: MRI Correlation With Results
Banks Deal, MD, Ed Smith, MD, Wendell Heard, MD, Michael J O’Brien, MD, and Felix H. Savoie, III, MD. November 2017. Orthopedic Journal of Sports Medicine.
