Platelet-rich-plasma (PRP) injections use components of the body’s own blood to stimulate healing. Platelets, which are usually associated with coagulation (clotting), are also, according to recent research, able to assist in mending and strengthening damaged tissue by increasing certain growth factors. During the normal healing process, the body uses platelets to promote new-tissue growth and repair injuries. By supplementing platelet content, the healing process is accelerated. There is ongoing research on the efficacy of PRP injections, and some medical professionals remain skeptical about their value.
Conditions Treated With A PRP Injection
A PRP injection can be used to treat a wide range of orthopedic conditions, including the following:
- Joint pain
- Ligament sprains or tears
- Nerve inflammation
- Postsurgical healing from tendon or ligament repair
PRP injection therapy is also used to promote rapid healing after nonorthopedic surgeries, including cosmetic ones.
Benefits Of A PRP Injection
There are several benefits to PRP injection therapy. They include the fact that the platelet-rich plasma being injected is autologous (comes from the patient), so there is no risk of cross-reactivity, immune reaction or disease transmission. It is also minimally invasive (unlike surgery), and facilitates healing (unlike corticosteroids).
The PRP Injection Procedure
During the PRP injection procedure, which usually incorporates ultrasound imaging, a small amount of blood is withdrawn from the patient. This blood is processed in a centrifuge to separate its various elements, and concentrate the platelets. The resulting plasma is up to five times more concentrated with platelets than “natural” blood. Once concentrated, the platelets are loaded, along with some of the patient’s whole blood, into a sterile syringe, and injected into the patient.
The procedure is usually performed under local anesthetic in a physician’s office. A typical patient experiences little or no discomfort from the injection, but the injection site is usually inflamed and sore for about 48 hours. Taking pain medication and applying ice are recommended.
Most patients require one to three PRP injections, about 4 to 6 weeks apart, in order to achieve optimal results. Occasionally, a fourth injection is necessary. Typically, by the fifth day after an injection, the patient has a significant reduction in pain, and can begin physical therapy.
Risks Of A PRP Injection
Although a PRP injection is generally safe and effective, sterilization is of great importance. There is a slight chance of infection or blood clots, and the remote possibility of allergic reaction.
Click to Learn More About PRP, Bone Marrow Aspirate Injections & Biologics
Treatment with biologics is relatively new science. As such, we orthopedic surgeons cannot without reservation say that it will absolutely work for everyone. Studies are ongoing to determine if the treatment is in fact superior to alternative therapies and exactly how much of which biologic, in which form, and in what regimen results would be optimized. So far, results have been promising. But it is not for everyone or every problem. In fact, there are both patient types and disease states in which treatment with biologics is indicated as well as those in which biologic therapy is contraindicated.
Platelet Rich Plasma (PRP) is just that; it is plasma with an increased number of platelets compared to plasma currently in your bloodstream. An orthopedic surgeon achieves this by drawing whole blood from a patient into a tube or tubes, and centrifuging the tube(s) twice. This in-office process forces platelets and perhaps more importantly, growth factors to the bottom of the tube. These growth factors and platelets have documented roles in the healing process and may promote the body’s own ability to heal itself. The surgeon retrieves the portion of the plasma containing the platelets and healing factors and injects this into the joint or injured tendon of interest with the focus on stimulating reparation of the damaged tissues using the patient’s own reparative means.
Despite the current studies and important work ongoing, PRP injections and biologics therapy in general remains a therapy that patients must pay for themselves. A growing body of clinical research is regularly providing a better understanding of the benefits resulting from the therapeutic use of PRP in orthopedics. Still, many insurance companies flatly will not pay for PRP injections, or any other biologic intervention on the premise that these treatments are deemed “investigational,” and thereby not covered by insurance. But that still allows patients who opt for the treatments to do so on a fee-for-service basis, making payments directly to their surgeon’s office, and still be able to participate in what appears to be a promising new area of medical care.
Current study results appear to support the validity of benefit from PRP injections and biologic use. Especially in injury states such as rotator cuff repair, hamstring injury, chronic Achilles tendonopathy, and lateral epicondylitis, all conditions with typically protracted healing times, the judicious use of PRP injections offers a decrease in convalescence combined with the possibility of more robust healing and recuperation. The use of PRP in cases of knee osteoarthritis has also demonstrated significant healing of both damaged cartilage and meniscal tissues. Pain reduction and improved clinical scores have been documented at 12-month follow ups, although it has not been proven more effective than injections with viscosupplementation in every case. Younger patients, with less degeneration appear to respond more favorably than older patients and more advanced disease, where the results of viscosupplementation and PRP are more similar (interestingly, many insurers will also refuse to pay for viscosupplementation).
In conclusion, the jury is still out on the ultimate validity of the use of biologics. However, pending the outcome of ongoing and future study results, adding biologic therapy to the orthopedic surgeons armamentarium has the very real potential to revolutionize the way we address many of the injuries and age-related ailments we see in our patients. We eagerly await these results in order to improve patient outcomes.