| The Basics of Platelet Rich Plasma Therapy
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The Basics of Platelet Rich Plasma Therapy

The Basics of Platelet Rich Plasma Therapy

Platelet-rich plasma (PRP) is a solution of concentrated platelets. PRP has a high concentration of bioactive growth factors that promote healing when administered to injured, damaged, or degenerated body structures. The average concentration of platelets in whole blood is 200,000 per μl (normal range 150,000–350,000 per μl). The platelets are concentrated in the laboratory through an intricate centrifugation process (spinning device).

Benefits of PRP

Platelets are essential to tissue healing. When an injury occurs, platelets are activated, which cause clot formation and release various growth factors from the α-granules (the storage units). Within 10 minutes of PRP administration or injury, 95% of growth factors are released.

Endothelium growth factors, fibroblast growth factors, insulin-like growth factor-1, transforming growth factors-β, and vascular endothelium growth factors. Complex interactions of these differentiation and growth factors, combined with adhesive protein factors (vitronectin and fibronectin) will promote the long regenerative process of chemotaxis, stimulate healing, remove tissue debris, and form extracellular matrix, osteoid, and collagen.

Different Types of PRP Solution

There are four categories of platelet concentration preparation:

  • Leukocyte-poor (pure PRP)
  • Leukocyte PRP
  • Pure platelet-rich fibrin clot
  • Leukocyte platelet-rich fibrin clot

Duration of centrifugation and force of spinning are factors that determine the platelet concentration levels and various compositions. Each of these four solutions have separate biological effects and uses.

Clinical Indications

Orthopedic specialists and neurosurgeons are using PRP therapy more and more for a variety of conditions and injuries. These include:

  • Post-operative wound healing
  • Rotator cuff repair integrity
  • Chronic tendinopathies
  • Ligament damage
  • Degenerative joint disease
  • Epicondylitis
  • Bone healing and spinal fusion
  • Chronic wounds
  • Shoulder surgery
  • Anterior cruciate ligament tears

Healing Mechanisms

PRP works through an intricate process that is categorized into three phases: inflammation, proliferation, and remodeling. After tissue injury or damage occurs, a hematoma may form. Bleeding releases platelets during the inflammatory phase, which begins platelet action by release of hemostatic factors and growth factors.

Within a few days of platelet action, the proliferative phase starts, which is characterized by collagen deposition, angiogenesis, granulation tissue formation, wound contraction, and epithelialization. After several weeks, or 1-2 months, the remodeling phase begins. This involves collagen maturation and new cell and tissue growth.

Preparation

Obtaining platelet-rich plasma is a simple procedure. A nurse will draw around 60 milliliters of blood from your vein. The blood is placed in a small amount of anticoagulant, which is down inside the collection tube. The tubes are placed in a centrifuge, which separates the red cells and other blood components from the platelets. After the spinning process, the solution is placed in syringes and placed in an LED system, which activates the growth factors. PRP is ready to use in 10-20 minutes.

Administration

PRP injections often include a calcium or thrombin solution. Studies have shown that tendons, joints, and other body parts being injected will activate the solution on their own. The skin over the area injected is cleaned using an antiseptic, and then it is numbed with an anesthetic. Using real-time x-ray, the procedure needle is inserted near the injured structure. After the PRP solution is instilled, the needle is removed. During surgery, PRP can be placed directly on the repaired tendon, ligament, or muscle structure.

Results

Many clinical studies have demonstrated the efficacy of PRP therapy. In a recent study, PRP had a positive clinical effect on human stem cell proliferation, increasing PRP concentration and cell numbers to around 10%. In a randomized clinical trial involving patients with plantar fasciitis, 30 were given PRP therapy and the other 30 received a local steroid injection.

Results were based on visual analog scores. According to scores, patients who had PRP therapy had less pain at three and six months following the procedure. Another study found that PRP completely resolved the plantar fasciitis symptoms in the majority of patients, with a 78% success rate.

 

Dr. Zed at All Star Pain Management offers first rate PRP therapy at two locations in Annapolis and Glen Burnie MD. Platelet Rich Plasma Therapy offers patients an exceptional option for nonoperative pain relief and the possibility of getting back to desired activities. Call us today and find out if you are a candidate!

Resources

de Mos M., van der Windt A.E., Jahr H. Can platelet-rich plasma enhance tendon repair? A cell culture study. Am J Sports Med. 2008;36:1171–1178.

Griffin X.L., Smith C.M., Costa M.L. The clinical use of platelet-rich plasma in the promotion of bone healing: a systematic review. Injury. 2009;40:158–162. [PubMed]

Housner J.A., Jacobson J.A., Misko R. Sonographically guided percutaneous needle tenotomy for the treatment of chronic tendinosis. J Ultrasound Med. 2009;28:1187–1192.

Lyras D.N., Kazakos K., Agrogiannis G. Experimental study of tendon healing early phase: is IGF-1 expression influenced by platelet rich plasma gel? Orthop Traumatol Surg Res. 2010;96:381–387.

McShane J.M., Nazarian L.N., Harwood M.I. Sonographically guided percutaneous needle tenotomy for treatment of common extensor tendinosis in the elbow. J Ultrasound Med. 2006;25:1281–1289.

Park E.J., Kim E.S., Weber H.P., Wright R.F., Mooney D.J. Improved bone healing by angiogenic factor enriched platelet-rich plasma and its synergistic enhancement by bone morphogenetic protein-2. Int J Oral Maxillofac Implant. 2008;23:818–826.

Rabago D., Best T.M., Zgierska A.E., Zeisig E., Ryan M., Crane D. A systematic review of four injection therapies for lateral epicondylosis: prolotherapy, polidocanol, whole blood and platelet-rich plasma. Br J Sports Med. 2009;43:471–481.

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