Platelet-Rich Plasma (PRP) Therapy

Whole blood is composed of three primary constituents: Red Blood Cells (RBCs), White Blood Cells (WBCs), and Plasma. The function of the RBCs is to carry and transport oxygen (they are important for endurance athletes). WBCs fight infection. Diseases like leukemia, lymphoma, and HIV stem from problems with the WBC. Within the plasma are small cells called platelets. The platelets are best known for their importance in clotting blood. However, platelets also contain hundreds of proteins called growth factors which are critically important in the healing of injuries.

PRP is plasma with many more platelets than what is typically found in whole blood. By drawing whole blood and putting it through a centrifugation process, we are able to concentrate the platelets. The concentration of platelets — and, thereby, the concentration of growth factors — can be 5 to 10 times greater (or richer) than usual.

To develop a PRP preparation, blood must first be drawn from a patient (usually between 30 and 60cc of whole blood). The platelets are separated from the other blood cells and their concentration is increased during a process called centrifugation (ie. spinning the blood). The final PRP product is separated and injected back into the patient at the source of injury, ultimately augmenting the natural healing response of the body while expediting recovery.

What Conditions Are Treated With PRP? Is It Effective?

PRP has been studied extensively over the past few years. There are hundreds of studies published that review its effectiveness and compare it to previously used “gold standards” (ex. corticosteroids). PRP has been shown to be effective for these conditions and many others:

• Chronic Tendon Injuries (ex. Tennis Elbow, Golfer’s Elbow, Jumper’s Knee (Patella Tendinitis))
• Acute Tendon, Ligament, and Muscle Injuries (ex. Achilles Tendon Injuries)
• Osteoarthritis (Knee, Hip, Shoulder, etc)
• Rotator Cuff tears in the shoulder
• Bursitis (Hip, Knee, Shoulder)

Studies Supporting the use of PRP:

Osteoarthritis

• Efficacy of Intra-articular Platelet-Rich Plasma Injections in Knee Osteoarthritis: A Systematic Review. Arthroscopy (2016).
• Platelet-rich plasma in the management of articular cartilage pathology: a systematic review. CJSM (2014).
• Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for the Treatment of Knee Osteoarthritis. AJSM (2017).
• Ultrasound-Guided Injection of Platelet-Rich Plasma and Hyaluronic Acid, Separately and in Combination, for Hip Osteoarthritis: A Randomized Controlled Study. AJSM (2016).
• Short-term outcomes of platelet-rich plasma injection for treatment of osteoarthritis of the knee. KSSTA (2016).
• Efficacy of Platelet-Rich Plasma in the Treatment of Knee Osteoarthritis: A Meta-analysis of Randomized Controlled Trials. Arthroscopy (2017).
• The temporal effect of platelet-rich plasma on pain and physical function in the treatment of kneeosteoarthritis: systematic review and meta-analysis of randomized controlled trials. J Orthop Surg Res (2017).
• Hyaluronic Acid Versus Platelet-Rich Plasma: A Prospective, Double-Blind Randomized Controlled Trial Comparing Clinical Outcomes and Effects on Intra-articular Biology for theTreatment of Knee Osteoarthritis. AJSM (2017).
• Does Intra-articular Platelet-Rich Plasma Injection Provide Clinically Superior Outcomes Compared With Other Therapies in the Treatment of Knee Osteoarthritis? A Systematic Review of Overlapping Meta-analyses. Arthroscopy (2015).
• Safety and Efficacy of Intra-articular Injection of Platelet-Rich Plasma in Patients With AnkleOsteoarthritis. Foot Ankle Int (2017).

Tendinopathy and Tendonitis of the Elbow:

• Platelet-rich plasma versus corticosteroid injection for recalcitrant lateral epicondylitis: clinical and ultrasonographic evaluation. J Orthop Surg (2015).
• Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. AJSM (2014).
• Platelet-rich plasma versus autologous blood versus steroid injection in lateral epicondylitis: systematic review and network meta-analysis. J Orthop Traumatol (2016).
• Single injection of platelet-rich plasma (PRP) for the treatment of refractory distal biceps tendonitis: long-term results of a prospective multicenter cohort study. KSSTA (2016).
• Ultrasound-guided platelet-rich plasma injection for distal biceps tendinopathy. Shoulder and Elbow (2015).
• Growth factor-based therapies provide additional benefit beyond physical therapy in resistant elbow tendinopathy: a prospective, single-blind, randomised trial of autologous blood injections versus platelet-rich plasma injections. Br J Sports Med (2011).

Hip Conditions: Tendinopathy and Bursitis

• The Effectiveness of Platelet-Rich Plasma Injections in Gluteal Tendinopathy: A Randomized, Double-Blind Controlled Trial Comparing a Single Platelet-Rich Plasma Injection With a Single Corticosteroid Injection. AJSM (2018).
• Platelet-Rich Plasma Injections With Needle Tenotomy for Gluteus Medius Tendinopathy: A Registry Study With Prospective Follow-up. Orthop J Sports Med (2016).
• Greater Trochanteric Pain Syndrome: Percutaneous Tendon Fenestration Versus Platelet-Rich Plasma Injection for Treatment of Gluteal Tendinosis. J Ultrasound Med (2016).

Hip Conditions: Tendinopathy and Bursitis

• Effects of bone marrow aspirate concentrate and platelet-rich plasma on patients with partial tear of the rotator cuff tendon. J Orthop Surg Res (2018).
• The Efficacy of Platelet-Rich Plasma on Tendon and Ligament Healing: A Systematic Review and Meta-analysis With Bias Assessment. AJSM (2017).
• Impact of Platelet-Rich Plasma on Arthroscopic Repair of Small- to Medium-Sized Rotator CuffTears: A Randomized Controlled Trial. Orthop J Sports Med (2016).
• Does application of moderately concentrated platelet-rich plasma improve clinical and structural outcome after arthroscopic repair of medium-sized to large rotator cuff tear? A randomized controlled trial. J Shoulder Elbow Surg (2016).
• Leukocyte-Reduced Platelet-Rich Plasma Normalizes Matrix Metabolism in Torn Human Rotator Cuff Tendons. AJSM (2015).
• The effect of subacromial injections of autologous conditioned plasma versus cortisone for the treatment of symptomatic partial rotator cuff tears. KSSTA (2016).
• Platelet-rich plasma for arthroscopic repair of medium to large rotator cuff tears: a randomized controlled trial. AJSM (2015).

Dr. Dold is widely considered an expert in PRP and other biologic therapies. These treatments are minimally invasive and can be performed in clinic, often negating the need for surgery. If you are considering PRP as a treatment option for you, please contact us for a consultation: 469.850.0680.

Viscosupplementation

Another treatment option is a procedure called viscosupplementation. If you have tried all other nonsurgical treatment methods and your pain continues to limit your activities, viscosupplementation may be an option.

In this procedure, a gel-like fluid called hyaluronic acid is injected into the knee joint. Hyaluronic acid is a naturally occurring substance found in the synovial fluid surrounding joints. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for joint loads. People with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints. The theory is that adding hyaluronic acid to the arthritic joint will facilitate movement and reduce pain.

The most recent research, however, has not found viscosupplementation to be effective at significantly reducing pain or improving function. Although some patients report pain relief with the procedure, some people are not helped by the injections.

The two primary sources of mesenchymal stem cells (MSCs) are our bone marrow and adipose tissue (ie. fat!). Adipose tissue (that’s right, the fat around our abdomen) is a rich source of these regenerative MSCs and can be harvested to produce a solution used to heal injuries and regenerate tissue. The lipoaspirate procedure is performed in clinic under local anesthetic. The entire procedure is usually performed in under and hour. Adipose tissue is typically harvested from the abdominal area and is then concentrated in a specialized centrifuge to produce a mesenchymal stem cell graft or solution that is injected at the desired site of treatment (ex. knee joint, rotator cuff, Achilles tendon, etc). Adipose-derived stem cells (ASCs) provide a promising future in the field of tissue engineering and regenerative medicine. Due to their wide availability and ability to differentiate into other tissue types of the musculoskeletal system, including bone, cartilage, muscle, and tendon, ASCs may serve a wide variety of applications. In comparison to bone marrow-derived stem cells, the amount of ASCs is roughly 500-fold greater when isolated from an equivalent amount of adipose tissue. Why not use this unwanted tissue for something good?!

Contact Dr. Dold to see if you are a candidate for a lipoaspirate procedure which might help you avoid surgery.

• Intra-Articular Injection Of Autologous Adipose-Derived Mesenchymal Stem Cells In The Treatment Of Knee Osteoarthritis.
• Intra-Articular Injection Of Mesenchymal Stem Cells For The Treatment Of Osteoarthritis Of The Knee: A 2-Year Follow-Up Study.
• Mesenchymal Stem Cell Injections Improve Symptoms Of Knee Osteoarthritis.
• Adipose Tissue-Derived Mesenchymal Stem Cells And Platelet-Rich Plasma: Stem Cell Transplantation Methods That Enhance Stemness.
• Intra-Articular Injection Of Mesenchymal Stem Cells For The Treatment Of Osteoarthritis Of The Knee: A Proof-Of-Concept Clinical Trial.
  
• Adipose Mesenchymal Stromal Cell-Based Therapy For Severe Osteoarthritis Of The Knee: A Phase I Dose-Escalation Trial.