Over the years, the use of Platelet rich plasma has become routine and its effectiveness in the treatment of many musculoskeletal conditions is well reported.
What is Platelet Rich Plasma (PRP)?
Although blood is mainly a liquid (called plasma), it also contains small solid cell components (red cells, white cells, and platelets). The platelets are essential for blood clotting. However, platelets also contain hundreds of proteins called growth factors that 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 thus, the concentration of growth factors can be 5 to 10 times greater than usual.
To develop a PRP preparation, blood is first drawn from a patient. The platelets are then separated from other blood cells and their concentration is increased during a process called centrifugation. This fluid(plasma) that is rich in Platelets is then injected into the injured area.
Extensive research studies have been conducted to evaluate the effectiveness of PRP in a variety of acute and chronic musculoskeletal conditions.
- Chronic tendon Injuries: Current Research suggests that that PRP is effective in the treatment of chronic tendon conditions like Tennis Elbow (Lateral Epicondylitis), Chronic Achilles Tendonitis and Patellar Tendonitis (Jumper’s Knee).
- Acute Muscle and Ligament Injuries: PRP has been used in professional athletes in the treatment of acute muscle or ligament injuries. E.g. pulled Hamstring muscles in the thigh or acute knee ligament sprain.
- Osteoarthritis: More and more literature is now available showing the effectiveness of PRP in the treatment of low and moderate grade Knee and Hip Arthritis. Some studies have shown that the results can last up to 2 years. The goal is to reduce the pain, improve function and hopefully slow/halt the progress of damage to cartilage.
It is not very clear how exactly PRP works. However, laboratory studies have shown that high concentrations of growth factors can potentially speed up the healing process.
To speed up the healing process, the PRP should be delivered to the injury site. This is a precise process, and it can be delivered either carefully injecting the PRP into the injured area or arthritic joint either directly or by X-ray/Ultrasound guidance. For some injuries, PRP can also be used during surgery.
Many factors influence the effectiveness of the PRP preparation. These include:
- The area of body being treated.
- The overall health of the patient.
- Whether the injury is acute or chronic
- Patient characteristics: Blood composition with the number of platelets can differ from patient to patient.
- How the blood is processed: centrifuge or filtered
- Any additives added (thrombin and calcium chloride) may affect the efficacy.
Certain precautions are essential prior to injecting the PRP
- Corticosteroids are avoided for 2-3 weeks and NSAIDs for 1 week prior to the procedure.
- Discontinue anticoagulation medication for 5 days before the procedure.
- Drink plenty of fluids the day before the procedure
This is an outpatient procedure that involves drawing blood, preparation of the PRP, and the injection:
- Blood is drawn from a vein in the patient's arm into a vial (6-20mls)
- The blood is processed using a centrifuge machine.
- A doctor or technician prepares the centrifuged platelet-rich plasma for injection.
- The affected joint area is cleansed with disinfectant such as alcohol or iodine.
- If ultrasound is being used, a special gel will be applied to an area of skin near the injection site. An ultrasound probe will be pressed against the gel-covered skin. A live image of the joint will be projected onscreen for the doctor to see.
- The patient is asked to relax; this will facilitate the injection and can make the injection less painful.
- Using a syringe and needle, the doctor injects a small amount (often just 3 to 6 mL) of platelet-rich plasma into the joint capsule.
- The injection area is cleansed and bandaged.
The platelet-rich plasma typically stimulates a series of biological responses, and the injection site may be swollen and painful for about 3 days.
Patients are advised to take it easy for a few days and avoid strenuous activities for a few days.
The Specialist may suggest that a patient:
- Does not take anti-inflammatory pain medication; another pain medication may be prescribed.
- Wear a brace or sling to protect and immobilize the affected joint or area; a patient who receives an injection at the ankle, knee, or hip may be advised to use crutches.
- Use a cold compress a few times a day for 10 to 20 minutes at a time to help decrease post-injection pain and swelling.