PRP (Autologous Blood)

PRP stands for platelet rich plasma. The medical community has been using PRP since the 1970s. At first, it was used as a surgical glue, and since then, it has been used by dental surgeons to enhance wound healing in jaw reconstruction.

Orthopedic surgeons started using PRP in the late 90s to repair bone fractures experiencing delayed healing, and eventually for chronic tendinitis, partial tears (tendon ligaments, muscles), cartilage damage, and osteoarthritis. Recently, it has also been used as a cosmetic procedure (face and scalp).

Platelets contain various components that are effective in tissue repair:

Connective tissue growth factor (effective on cartilage, tendons, ligaments, bone growths)

  • Insulin-like growth factors: IGF-1 and IGF-2 (increase tissue proliferation, decrease inflammation
  • Vascular endothelial growth factor
  • Epidermal growth factor (EGF)
  • Fibroblast growth factor (helps wound healing, aesthetics)
  • Keratinocyte growth factor (helps wound healing, aesthetics) · Interleukin 8
  • Transforming growth factor beta (TGFβ)

PRP is an elective treatment for sub-acute and chronic conditions. PRP promotes increased healing of the damage tissue by bringing growth factors to the site of injection, extracting mesenchymal stem cells (MSC) from the blood vessels and increasing stem cell proliferation and blood supply.

Before injecting the PRP, the platelets are “harvested”. This involves a basic blood draw from the patient. The blood is then put inside a special centrifuge machine (that is FDA approved). This process takes about 20 minutes. Because it is the patient’s blood that is used in the procedure (autologous), PRP injections are very safe.

Tissue takes 6-12 weeks to heal. After 6 weeks, a second dose of PRP may be injected depending on the outcome of the first procedure.

Examples of indication for PRP:

  • Osteoarthritis (knee, hip, ankle, shoulder, etc.)
  • Small meniscus tear
  • ACL sprains (not a complete tear)
  • Partial tears of tendons (hamstrings, tibialis posterior, Achilles, patellar, rotator cuff) ·
  • Chronic tendinopathy (epicondylitis, De Quervain, plantar fasciitis)
  • Wrinkles
  • Certain form of alopecia (hair loss)

Contraindications:

  • Wound or infection
  • Coagulation disease

After the PRP procedure:

  • Do NOT ice the area for 2 days
  • Do NOT take non-steroidal anti-inflammatory medicine (Ibuprofen, Aleve, Advil, etc.) for four weeks

Bibliography:

  1. E. Anitua, M. Sanchez, A.T. Nurden, M. M. Zalduendo, M. de la Fuenta, J. Azofra and I.Andia. Platelet-released growth factors enhance the secretion of hyaluronic acid and induce hepatocyte growth factor production by synovial fibroblasts from arthritic patients. Rheumatology, 2007; 46:1769-1772.
  2. G. Filardo, E. Kon, A. DiMartino, B. DiMatteo, M.L. Merli, A. Cenacchi, P. M. Fornasari and M. Marcacci. Platelet-rich plasma vs hyaluronic acid to treat knee degenerative pathology: study design and preliminary results of a randomized controlled trial. BMC Musculoskeletal Disorders, 2012; 13: 229.
  3. S. Pate, M. Dhillon, S. Aggarwal, N. Marwaha and A. Jain. Treatment with Platelet-Rich Plasma is more effective than placebo for knee osteoarthritis. The American Journal of Sports Medicine, 2013; Vol. XX, No. X: 1 – 9.
  4. Salamanna, F., Veronesi, F., Maglio, M., Della Bella, E. , Sartori, M and Fini, M. “New and Emerging Strategies in Platelet-Rich Plasma Application in Musculoskeletal Regenerative Procedures: General Overview on Still Open Questions and Outlook.” National Center for Biotechnology Information. 5 May 2016. Web. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4436449/
  5. Mlynarek, Ryan A., MD, Andrew W. MD, Kuhn, BA, MD and Asheesh Bedi, MD. “PlateletRich Plasma (PRP) in Orthopedic Sports Medicine.” The American Journal of Orthopedics. N.p., 27 June 2016. Web http://the-publication/issue-single-view/platelet-rich- plasmaprp-in-orthopedic-sports-medicine/4a692f7406c3f6065e2c0f66b259f123.html.
  6. Dines, Joshua S., MD, Phillip N. Williams, MD, and Neal ElAttrache, MD. “Platelet-Rich Plasma Can Be Used to Successfully Treat Elbow Ulnar Collateral Ligament Insufficiency in High-Level Throwers.” The American Journal of Orthopedics. N.p., 27 June 2016. Web. http://www.amjorthopedics.com/the-publication/issue-single-view/platelet-rich-plasmaprp- in-orthopedic-sports-medicine/4a692f7406c3f6065e2c0f66b259f123.html.
  7. Tejpar, Farah, MD. “A Role for Platelet-Rich Plasma in the Treatment of Early Knee Osteoarthritis.” The Cleveland Clinic. http://ghislainerobert.com/wp-content/uploads/2016/08/PRP-Study.pdf
  8. J Foot Ankle Surg. 2019 Jan;58(1):42-46. doi: 10.1053/j.jfas.2018.07.006. Epub 2018 Nov 15. “Platelet-Rich Plasma Has Better Long-Term Results Than Corticosteroids or Placebo for Chronic Plantar Fasciitis: Randomized Control Trial.” https://www.ncbi.nlm.nih.gov/pubmed/30551490
  9. Orthopade. 2019 Jan 8. doi: 10.1007/s00132-018-03659-5. [Epub] “Intra-articular injections of platelet-rich plasma, hyaluronic acid or corticosteroids for knee osteoarthritis : A prospective randomized controlled study.” https://www.ncbi.nlm.nih.gov/pubmed/30623236
  10. Saunders Journal of Prolotherapy. 2018;10:e992-e999. “A comparison of ultrasound guided PRP injection and prolotherapy for mechanical dysfunction of the sacroiliac joint”
  11. “Meta-analysis Comparing Platelet-Rich Plasma vs Hyaluronic Acid Injection in Patients with Knee Osteoarthritis.” Journal: Pain Medicine : the Official Journal of the American Academy of Pain Medicine. 2019 Mar 7; Authors: Yanhong Han, Hetao Huang, Jianke Pan, Jiongtong Lin, Lingfeng Zeng, Guihong Liang, Weiyi Yang, Jun Liu PMID: 30849177
  12. American Journal of Physical Medicine & Rehabilitation. 2019 Jan 23; “Single intra-articular platelet-rich plasma versus corticosteroid injections in the treatment of adhesive capsulitis of the shoulder: a cohort study.” Apurba Barman, Somnath Mukherjee, Jagannatha Sahoo, Rituparna Maity, P Bhaskar Rao, Mithilesh K Sinha, Dibyajyoti Sahoo, Sujit Tripathy, Binod Kumar Patro, Nerbadyswari Deep Bag
  13. International Journal of Molecular Sciences. 2019 Mar 5; 20 (5). “Development of Autologous Platelet-Rich Plasma Mixed-Microfat as an Advanced Therapy Medicinal Product for Intra-Articular Injection of Radio-Carpal Osteoarthritis: From Validation Data to Preliminary Clinical Results.” Alice Mayoly, Aurélie Iniesta, Caroline Curvale, Najib Kachouh, Charlotte Jaloux, Julia Eraud, Marie Vogtensperger, Julie Veran, Fanny Grimaud, Elisabeth Jouve, Dominique Casanova, Florence Sabatier, Régis Legré, Jérémy Magalon