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PRP Injection Therapy (Platelet-Rich Plasma)

Platelet-rich plasma therapy (PRP) 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. The below video is a collection of testimonials of our patients that have received Prolozone Therapy at our clinic.

Platelet-rich plasma is a preparation of autologous human plasma, with every unit of plasma –the liquid portion of the blood –consisting of increased platelet concentration. These platelets contain a rich deposit of growth factors stored as alpha granules. 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 triggered and released in different sites 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 tissue healing and reduce injury recovery time. In a normal blood extract, the Platelet Count ranges between 150,000 to 350,000 per microliter. At a concentration of above 1,000,000 per microliter, improved tissue healing and bone regeneration have been recorded. This observation drives the supervised use of platelet-rich plasma as a complementary therapy in injuries of the musculoskeletal systems and the 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 and adjunct therapy protocols have mainly witnessed an inflow of novel ideas over the last couple of years. These protocols offer complementary, alternative, and supportive treatment for disease conditions in humans. In sports medicine, the rising incidence of injury and the need to keep athletes in the right shape put pressure on sports medicine.

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. As it stands, platelet-rich plasma (PRP) therapy appears to be the newest kid on the block. From its introduction in the 1980s to its first use in Dentistry, PRP has gained wide 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 preparation characteristics of these products. For every system on the market, there are different parameters and values defining properties such as platelet capture efficiency, isolation method, type f 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 and subsequent blood screening, the blood sample is mixed with an anticoagulant factor and centrifuged. 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.

At first spin (Hard spin), the platelet-poor plasma is separated from the red fraction of and the platelet-rich plasma. The second and final spin (Soft spin) separates the red blood cells from platelet-rich plasma. The concentrated platelet layer is then separated using different isolation methods, producing platelet concertation of 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 –topical bovine thrombin and 10% calcium chloride. Activation immediately de-granulates the platelets and trigger the release of growth factors and bioactive substance involved in regenerative tissue healing.

Application of Platelet-Rich Plasma in Medicine

  • Treatment of Muscle Injury

This is perhaps the most popular indication of platelet-rich plasma in sports medicine. The biological processes involved in muscle repair start with local inflammatory response and end with cell proliferation, differentiation, and tissue remodeling. Many clinical studies and orthopedic assessments have produced convincing evidence suggesting that that supervised PRP injection regimen aids improved muscle healing in athletes. Although there is much theoretical evidence supporting PRP muscle tear injuries, the potential of muscle structure modification aided by PRP is still unproven.

  • Management of Tendon Injuries

PRP injections have long been proposed as supportive therapy in the treatment of tendon injuries.  The cytokines released by the concentrated volume of platelets in these injections are involved in the healing stage of tendinopathies. The growth factors released also promote vascularization of the injury site –an action that directly improves blood and nutrients supply to the healing tissue. In chronic tendon injuries, multiple PRP injections might be required for tendon healing. Reports from various trials and clinical studies 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 prompting regenerative tissue healing and cell differentiation. This makes PRP a viable tool in surgical procedures aimed at repairing and growing new tissue bundles. Several clinical studies have shown the effectiveness of PRP therapy in arthroscopic repair of rotator cuff tears. A platelet-rich fibrin matrix was used for surgical augmentation in these studies. PRP formulations directly injected into the repair sites releases abundant growth factors and cytokines that hastens the healing and tissue remodeling stages. As it stands, there are evidences 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 fracture. Modern medicine is poised to gain immensely from advanced studies in the potential s of PRP. The release of multiple growth factors by PRP injection s is a major advantage over single recombinant human growth factor delivery formulations. There are many studies currently investigating how PRP can be efficiently combined with surgery as a major 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.

Is PRP treatment painful?

PRP injections aren’t generally painful. Any pain experienced is only temporary. The site of the injection is thoroughly numbed before the injection to ensure maximum comfort during the procedure.

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.

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 okay to walk after an injection but 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 muscle around the knee. This is something we provide at our clinic alongside the injections.