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PRP Injection Therapy (Platelet-Rich Plasma)

Platelet-rich plasma therapy (PRP) is a simple outpatient procedure that helps to enhance the natural growth factors your body uses to heal tissue. We describe the difference between PRP injections and the more advanced Prolozone injections in this article.

Prolozone Therapy is a form of Prolotherapy that involves the injection of an activated form of oxygen and nutrients into an injured area. This helps to stimulate the production of fibroblasts. Fibroblasts help to secrete the collagen needed to repair and strengthen damaged or degenerated body tissue. The injected substance is very fine so it has the ability to spread into the injured area much more effectively than platelet-rich plasma injections. The below video is a collection of testimonials of our patients that have received Prolozone Therapy at our clinic.

A platelet-rich plasma injection is a preparation of autologous human plasma, consisting of a concentration of platelets. This concentration of platelets contains a rich deposit of growth factors stored as alpha granules. They also contain a small number of stem cells. The notable ones include platelet-derived growth factor (PDGF), insulin-like growth factor, vascular endothelium growth factor (VEGF), transforming growth factor-beta (TGF-β), and platelet-derived angiogenic factor (PDAF).

On physiologic activation of the platelets, these growth factors are released into a damaged soft tissue site in the body. Thrombin, collagen, and calcium chloride are notable stimuli known to trigger these growth factors. Primarily, these factors augment the natural process of soft tissue healing and recovery time of sports injuries such as tennis elbow. In a normal blood sample, the platelet count ranges between 150,000 to 350,000 per millilitre. At a concentration of above 1,000,000 per millilitre, improved tissue healing and bone regeneration have been recorded. This observation has inspired the use of platelet-rich plasma as a complementary therapy in injuries of the musculoskeletal system and soft tissues.

Preliminary observations also suggest that at an increased concentration as found in platelet-rich plasma, these growth factors speed up the biological cascades and regenerative stages involved in chemotaxis, proliferation, angiogenesis, and differentiation.  In addition to increased concertation of growth factors, the platelet concertation of PRP also releases multiple bioactive substances, including fibronectin, vitronectin, sphingosine, and 1-phosphate. These substances are important in regenerative tissue healing.

Tissue Injuries and Platelet-Rich Plasma Therapy

Regenerative medicine has seen an influx of different treatments over the last couple of years in healthcare. These treatments offer complementary, alternative, and supportive treatment for sports injuries such as golfer’s elbow. In sports medicine, the need to keep athletes in the right shape without cortisone injections and surgery has led to the popularity of PRP injection therapy. Professional athletes such as Tiger Woods have benefited from the treatment in the past.

In a 2017 publication, the United States Department of Health and Human Services published an analysis report suggesting that an estimate of 8.6 million sports-related injuries is reported annually. About 3% of these cases require hospitalizations, and a large percentage is injuries to the musculoskeletal system. To a large extent, this explains why sports stakeholders have consistently called for the introduction of affordable, non-invasive, and effective methods for the management of sports injuries in healthcare. From its introduction in the 1980s to its first use in Dentistry, PRP has gained worldwide recognition in sports and modern medicine.

Platelet-Rich Plasma: Preparation and Composition

Currently, there are many PRP systems commercially available on the market with variations in the composition, collection protocols and centrifuge systems. For every system on the market, there are different parameters and values defining properties such as platelet capture efficiency, isolation method, type of collection tube system, and the speed of centrifugation. Although these properties may differ, the core principle of PRP production is generally similar.

The formulation procedure starts with the collection of whole blood samples from the patient. After collection of the patients own blood, the blood sample is then mixed with an anticoagulant factor in a centrifuge. Centrifugation is done at a varying speed until the blood separates out into three distinct layers. The three layers consist of the platelet-poor plasma (PPP), red blood cells (RBC), and a buffy layer of concentrated leucocytes (white blood cells) and concentrated platelets.

A sample of blood being taken for a prp injection

 

The centrifuge separates the red blood cells from platelet-rich plasma. The concentrated platelet layer is then separated using different isolation methods, at least triple the concentration of the blood sample. The platelet-rich plasma layer can be directly injected into musculoskeletal injury sites or activated with a platelet activator to speed up the healing process. Activation immediately de-granulates the platelets and trigger the release of growth factors, stem cells and a bioactive substance involved in regenerative tissue healing. It is important to remember that this is a safe natural procedure as it involves a patient’s own blood (autologous) and nothing else.

Application of Platelet-Rich Plasma in Medicine

  • Treatment of Muscle Injury

This is perhaps the most popular indication of platelet-rich plasma injections in sports medicine. The biological processes involved in muscle repair start with local inflammatory response and end with cell proliferation, differentiation, and tissue remodelling. Many clinical studies and orthopaedic assessments have produced convincing evidence suggesting that a supervised PRP injection regimen speeds up the healing process.

A tennis player with shoulder pain needing platelet-rich plasma

  • Management of tendon problems

PRP injections have long been proposed as supportive therapy in the treatment of tendon problems and tendonitis in healthcare. They are a much safer alternative to cortisone. The cytokines released by the concentrated volume of platelets in these injections are involved in the healing stage of tendinopathies such as golfer’s elbow. The growth factors released at the injection site also promote vascularization of the injury site –an action that directly improves blood and nutrient supply to the healing tissue. In chronic tendon injuries, multiple PRP injections might be required for healing tendonitis. Reports from various clinical trials have shown evidence supporting the use of PRP in the management of Achilles tendinopathy, lateral epicondylitis, patellar tendinopathy, plantar fasciitis, and rotator cuff tendinopathy.

  • Surgical Augmentation

PRP injections are theoretically useful in promoting regenerative tissue healing and cell differentiation. This makes PRP a viable tool in orthopaedic procedures aimed at repairing and growing new tissue. Several clinical studies have shown the effectiveness of PRP therapy in arthroscopic repair of rotator cuff tears. Orthopaedic surgeons used a platelet-rich fibrin matrix for surgical augmentation in these studies. PRP formulations directly injected into the injury sites releases abundant growth factors and cytokines that speeds up the healing process. As it stands, there is evidence supporting the use of PRP in rotator cuff repair, Achilles tendon repair, and anterior cruciate ligament surgery.

PRP injections have also been reported to be beneficial in the management of other musculoskeletal conditions, including ankle sprains, osteoarthritis, and fractures. The release of multiple growth factors by PRP injections are a major advantage over single recombinant human growth factor delivery formulations. There are many studies currently investigating how orthopaedic surgeons efficiently combined PRP with surgery as an advanced therapy approach for patients in need of rapid bone and muscle regeneration.

FAQ’s

How long do PRP injections last?

The full effect of the injection can take up to several months to be felt. As the aim of the treatment is to repair, the effect is often lasting. Maximum results are normally achieved at between 6-9 months. Degenerative conditions such as knee osteoarthritis usually require a follow-up at some point.

Is PRP treatment painful?

PRP injections aren’t generally painful. Any pain experienced around the injection site is only temporary. The site of the injection is thoroughly numbed before the injection to ensure maximum comfort during the procedure. It is okay to take some paracetamol before the procedure but not anti-inflammatory medications such as ibuprofen.

What is the success rate of PRP injections?

The success rate depends on the condition or injury being treated. On average, PRP treatment has an 80% success rate.

How many PRP injections are needed?

One to three injections are required to achieve optimum results. As stated above, a follow-up may be required for conditions such as knee osteoarthritis.

How often should PRP injections be given?

If you require more than one injection then they should be performed one month apart from each other.

Can you walk after PRP injection?

It is a simple outpatient procedure so you are able to walk after the injection, although it is not advised to walk more than you would normally walk in a day.

Is PRP good for arthritis?

PRP treatment has shown to be effective for mild to moderate osteoarthritis. It can still be effective for severe arthritis but only if it is combined with a tailored exercise program to strengthen the muscles around the knee. This is something we provide at our clinic alongside the injections. PRP is a much safer alternative to cortisone. The medical department of Boston University published an article in 2019 highlighting the dangers of cortisone for hip and knee osteoarthritis.

Can I take painkillers after the procedure?

It is okay to take paracetamol but not anti-inflammatory medications such as ibuprofen.

Are there side effects associated with PRP therapy?

The only main side effect associated with PRP therapy is soreness that can last up to a week.

Can platelet-rich plasma therapy be used for any other conditions?

PRP injections are a common treatment for hair loss and alopecia. It is also used to improve the appearance of skin and is endorsed by the American Academy of Dermatology. autologous platelet treatment can also be used for wound healing.

Can I still perform physiotherapy exercises after the treatment?

It is still okay to perform gentle non-weight bearing physiotherapy exercises prescribed by a physiotherapist after platelet-rich plasma treatment.

Are there contraindications?

We do not advise individuals with blood clotting problems to have the treatment.