Bone and soft tissue injuries heal in many stages. One of the most exciting areas of research in orthopedics and sports medicine involves making the most of the initial healing stages: inflammation and an increase in cells, or cell proliferation. Platelet Rich Plasma (PRP) treatment is becoming a more popular option for giving a biological boost to the healing process. PRP treatment has received significant attention from the media and has been used by members of the New York Giants NFL football team, as well as other NFL players, and elite athletes.
What is PRP?
PRP is produced from a person’s own blood. It is a concentration of one type of cell, known as platelets, which circulate through the blood and are critical for blood clotting. Platelets and the liquid plasma portion of the blood contain many factors that are essential for the cell recruitment, multiplication, and specialization required for healing. After a blood sample is obtained from a patient, the blood is put into a centrifuge, which is a tool that separates the blood into its many components. Platelet rich plasma can then be collected and treated before it is delivered to an injured area of bone or soft tissue, such as a tendon or ligament. PRP is given to patients through an injection with the help of ultrasound guidance to assist in the precise placement of PRP. After the injection, a patient must avoid exercise for a short period of time before beginning a rehabilitation exercise program.
Is PRP Treatment Effective?
Several basic science studies in animal models suggest that PRP treatment can improve healing in soft tissue and bone. For example, increased numbers of cells and improved tendon strength have been noted in Achilles tendon injuries. In addition, improved muscle regeneration has been shown in gastrocnemius (calf) muscle injuries as well. These favorable findings have led to the widespread use of PRP treatment for a variety of conditions, including acute and chronic tendon problems, as well as ligaments and muscle injuries. Early-stage clinical studies in humans have been promising, but are limited by their study design and few patients. The most promising early results have been seen when PRP treatment is used for chronic tendon conditions, such as lateral epicondylitis (tennis elbow) and Achilles tendinosis. In a small study involving knee osteoarthritis, PRP treatment was shown to be more effective than hyaluronic acid treatment. PRP has also resulted in positive or similar results when used in the treatment of rotator cuff tears and medial collateral ligament (MCL) injuries in the knee. Overall, there is limited support of PRP treatment in published clinical studies. However, because PRP is created from a patient’s own blood, it is considered a relatively low-risk treatment with the potential to improve or speed healing. More studies are needed to prove the effectiveness of PRP treatment and to research the best ways to standardize the treatment’s preparation.
Concerns Involving PRP Treatment
Due to how PRP is given in the hopes of optimizing the initial inflammatory response of healing, anti-inflammatory medications should likely be stopped at the time of PRP treatment. Also, PRP does contain endogenous growth factors, so some agencies consider it to be a performance-enhancing substance. For instance, the World Anti-Doping Agency and the United States Anti-Doping Agency forbid the injection of PRP within muscles because of the possibility that the growth factors could enhance a person’s performance. However, there is no current data to suggest that PRP is actually a performance-enhancing substance. Major professional sports leagues have not yet addressed the topic of PRP.
Key Points to Remember
- Platelet Rich Plasma (PRP) comes from a patient’s own blood.
- PRP is a concentrated source of growth factors and cellular signaling factors that play a significant role in the biology of healing.
- Basic science studies show that PRP treatment may improve healing in many tissues.
- Few clinical studies in humans show the effectiveness of PRP treatment.
- Anti-inflammatory medicines should be stopped before and after PRP treatment is given.
While PRP treatment is relatively new, considered experimental and not FDA approved, it is a low risk procedure, and many ONS patients find it to be beneficial. At ONS patients who receive PRP are closely followed to study the effectiveness of the treatment and to identify which conditions benefit most from PRP.