Stem Cell

PLATELET RICH PLASMA (PRP)

 

  1. PRP also increases the effectiveness of the STEM CELLS to help decrease inflammation.

    PRP also increases the effectiveness of the STEM CELLS to help decrease inflammation.

    PRP (PLATELET RICH PLASMA) is where a small volume of blood plasma is concentrated through a centrifuge to produce the resultant high potency PLATELETS. Platelets are blood cells that aide in clotting. Also, PLATELETS are rich in growth factors that help in:

    1. Pain reduction.
    2. Tissue healing.
    3. Tissue repair.
    4. Bone regeneration.
    5. Development of new blood vessels.
    6. Stimulate wound healing.
  2. PRP stimulates the growth of collagen which is the main component of connective tissue such as tendons and cartilage.
  3. PRP contains growth factors that attract and recruit STEM CELLS to the area of tissue damage.
  4. PRP also increases the effectiveness of the STEM CELLS to help decrease inflammation.
  5. Medical literature indicates that the most successful areas to treat PRP are:
    1. Heel – – Plantar Fascitis pain.
    2. Knee – – Patella Tendonitis.
    3. Elbow – – Lateral Epicondylitis
    4. Shoulder – – Tendonitis or Rotator Cuff tear.

 

INTRODUCTION

  1. Tendinopathy is a common and perplexing problem facing clinicians. It is the most common reason (30%) that patients seek medical attention for a musculoskeletal condition. Tendon pain is common in recreational and professional athletes as well as sedentary people.
  1. Initially, tendinopathy was considered inflammatory (itis for example tendonitis), but this has changed over the years whereby now it is considered degenerative (opathy) and characterized by the following:
    1. Hypercellularity
    2. Vascular hyperplasia.
    3. Collagen disorganization.
  1. We are now trying to regenerate the tendon by using PRP and/or STEM CELLS, and also decreasing the pain.
  1. Tendinosis is when healing becomes chronically impaired as evidenced by:
    1. Lack of inflammatory cells in the tissue.
    2. Abnormal tissue repair.
    3. Collagen degeneration.
    4. Neovascularization
    5. Thickening of the tendon.
  1. THE POWER OF PLATELETS in treatment:
    1. Platelets are not just for clotting anymore.
    2. They are cells involved in wound healing.
    3. Platelets are the first cells to arrive at the site of injury.
    4. They are responsible for the initiation of the healing cascade.
    5. They secrete alpha granules and dense granules each of which have certain functions in regeneration and inflammation.

 

THE PRP PROCEDURE

  1. Platelet rich plasma injections have been proposed as a promising alternative for treating tendinopathies:
    1. PRP is an ideal blood product from the patient that promotes the body’s own natural healing.
    2. The blood (10 cc’s) taken from the patient’s arm is then centrifuged until the red blood cells and platelets separate, after which the platelets concentrate is extracted from the platelet rich section of the centrifuged plasma.
    3. The PRP is then filtered and separated. This increases the concentration of platelets and growth factors to approximately 400%. The number of platelets in PRP is approximately 4 to 8x normal.
    4. This concentrate is then injected into the tendon sheath (for example tennis elbow) under ultrasound guidance to help in decreasing inflammation and pain and increasing architectural changes and increasing positive architectural changes within the tendon.

 

Conditions PRP Therapy can help

What to expect after PRP Therapy

 

FUNCTIONS AND BENEFITS

  1. Platelets contain growth factors which are very important in the repair of tissues.
  2. When stimulated by tissue injury, platelets release these growth factors that do the following:
    1. Decrease pain.
    2. Promote wound healing.
    3. Increase collagen production for tendon healing and repair.
    4. Increase blood vessel growth for nutrition to the injured areas.
    5. Platelet growth factors attract and recruit mesenchymal stem cells.
    6. The growth factors can recruit other cells to help with repair.
    7. The growth factors can cause cells in the local area to differentiate into newly needed tissue. (Differentiation)
    8. The growth factors can prevent further soft tissue degeneration from occurring.
    9. It promotes tenocytes proliferation and production
    10. Stimulates gene expression of extracellular matrix constituents
    11. PLATELETS HAVE NO MAJOR RISK OR ADVERSE EFFECTS.
    12. Lower cost and shorter recovery time when compared to surgical management.

TECHNIQUE

  1. Tendinopathy is primarily a degenerative condition. Several new treatment options have been developed to attempt to stimulate tissue regeneration. There are two new treatments on the horizon:
    1. Percutaneous needle tenotomy – where the area of tendinopathy is repetitively fenestrated with a needle to disrupt tendinopathic tissue and induce bleeding.
    2. Platelet rich plasma.
      1. Platelet rich plasma is created from an autologous whole blood sample through a platelet separation which results in increased platelet concentration.
  2. It is theorized when PRP is injected into an area of tendinopathy the platelets release a multitude of growth factors and stimulate a healing response.
  3. Two major medical investigations have demonstrated significant improvement in subjects treated with platelet rich plasma with no adverse side effects.

Read more on the need for Ultrasound when receiving PRP Therapy

GENERAL PRP CONSENSUS

  1. IOC Consensus Paper on the Use of PRP and Sports Medicine – – British Journal of Sports Medicine 2010
    1. Suggested techniques and post injection recommendations.
    2. Use ultrasound.
    3. No consensus on whether the injection should be inside the tendon or around the tendon delivery.
    4. PRP used during arthroscopy – – Suggested delivery after emptying the joint of arthroscopic fluid.
    5. In open surgery – – The use of one of the gels and semi-solid forms is recommended.
    6. The question is should we stop nonsteroidals before PRP injections?
    7. No general agreement on post injection treatment.
      1. Rest, ice, limb elevation for 48 hours.
      2. Allow exercise after 2-5 days.
      3. Accelerated rehab under appropriate supervision.

 

CONCLUSION

  1. PRP is considered an ideal autologous blood product that promotes the body’s own natural healing.
  2. The use of platelet rich plasma for musculoskeletal injuries has increased significantly during the past few years due to its safety, availability and excellent results.
  3. It was found that 80% of patients who receive 1-2 injections of PRP and 76% of those who received three injections reported moderate to complete resolution of symptoms.
  4. PRP is an emerging therapeutic strategy that is currently practiced among certain pain practitioners.

There are many testimonials from patients, professional athletes (Tim Duncan, Dwight Howard, Kobe Bryant etc.), scientists and the Orthopedic and Pain Medicine field. – – A study in the American Journal of Sports Medicine showed that over 90% of patients at one year were “completely satisfied” with PRP’s outcomes.

David M. Hirsch, D.O. – Pain Medicine

John Hall, D.O – Pain Medicine

Dr. Ajeya Joshi – Orthopedic Surgery

 

RESEARCH in PLATELET RICH PLASMA (PRP) Injections

  1. Several studies have revealed under ultrasound that there are changes in tendon size (decrease) and good architectural changes suggesting that structural changes may occur after treatment with PRP.
  2. PRP is an effective and safe treatment for patients with chronic tendinopathy in a variety of locations to include, achilles tendon, lateral epicondylitis, the patella tendon, and several other tendons.
  3. In a major study by Finnoff et al of patients injected with PRP:
    1. 83% of subjects were satisfied with their outcome after the procedure.
    2. 83% would recommend the procedure to a friend.
    3. 82% had an improvement in the ultrasound analysis of the tendon echotexture.
    4. 82% had a decrease in the tendon vascularity.
    5. 38% had resolution of the intra-tendinous calcifications.
    6. No complications were reported.
    7. There was a mean improvement in the subjects function and worse pain scores of 68% and 58% respectively.
    8. In conclusion, Finoff’s study demonstrated improvements not only in pain but also in function and tendon structure after the PRP procedure. His study used tenotomy followed by PRP injection, then followed by a standardized post – procedural rehabilitation program.

PRP AND BONE

  1. Plachokova et al 2008 – –
    • PRP and bone regeneration in dentistry found evidence of the beneficial effects of PRP in the treatment of periodontal defects.

PRP AND MUSCLES

  1. PRP for treatment of hamstrings injuries – – Hamid et al – – American Journal of Sports Medicine 2014.
    • RESULTS – – A single autologous PRP injection combined with a rehab program was significantly more effective in treating hamstring injuries then a rehab program alone.

PRP AND TENDON

  1. Treatment of chronic severe elbow tendinosis with PRP – – Mishra et al 2006.
    1. RESULTS
      1. PRP treated patients showed significant improvement with a single injection that was sustained over time.
      2. No side effects.
      3. Significantly reduced pain (at 6 months post injection . . . 81% decreased pain).
      4. Mayo Clinic elbow scores improved 72% at 6 months post injection.
      5. Consider PRP before surgery was the conclusion of the paper.
  2. Treatment of Achilles tendinopathy with PRP – – Gaweda et al – – International Journal of Sports Medicine 2010.
    1. RESULTS – – PRP improved symptoms of non-insertional tendinopathy, pain scores, and the American
      Academy of Orthopedic Foot and Ankle Surgery scores improved for achilles tendinopathy with PRP.
  3. PRP for jumper’s knee – – Kon, Filardo 2009
    1. RESULTS – – Statistically significant improvement in all scores at 6 months follow up injection for jumper’s knee:
      1. Pain levels decreased.
      2. Sports activity levels increased.
      3. Percent of participants resuming sports after treatment increased.

 

PRP AND LIGAMENT

  1. Joshi . . Murray . . American Journal of Sports Medicine 2009
    • The addition of collagen – platelet composite used to supplement suture repair of an ACL repair enhanced the structural properties of the ACL, and the improvement is associated with increased cellularity within the healing ligament.

PRP AND CARTILAGE

  1. Ultrasound guided PRP injections for treatment of hip osteoarthritis – – Sanchez et al – Rheumatology 2011
    1. RESULTS – – Significant reductions at 7 months and 6 months seen in the following:
      1. VAS (pain scores).
      2. WOMAC score.
      3. Harris Hip Score for pain and function.
  2. PRP and knee arthritis – – Filardo and Kon 2011 (Knee Surgery for Sports Traumatol Arthroscopy – 2011)
    1. 114 knees injected with PRP in 91 patients with knee arthritis.
    2. RESULTS – –
      1. 78% improved after treatment.
      2. 73% improved after 6 months.
      3. 67% improved at 12 months.
      4. 54% improved at 24 months.
  3. Clinical and MRI outcomes after PRP treatment for early knee osteoarthritis – – Halpern et al – – Clinical Journal of Sports Medicine 2013.
    1. RESULTS – – Evaluation after one year with the following results:
      1. Pain scores significantly decreased.
      2. Functional scores and clinical scores increased.
      3. No MRI changes.
  4. Injection of PRP in patients with primary and secondary knee osteoarthritis – – Sampson et al – American Journal of Physcial Medicine and Rehabilitation, December 2010
    1. Three PRP injections of the knee at 4 week intervals.
    2. 52 weeks follow up.
    3. VAS – – Improvements with movement and rest activities.
      1. Improved expectation score and knee injury showed good improvement.
      2. Osteoarthritis outcome scores showed very good improvements.
      3. Sampson Found PRP works best in active patients with mild/moderate osteoarthritis of the knee
      4. Early Intervention for mild/moderate osteoarthritis is the key

 

PRP AND NERVE

  1. Efficacy of epidural perineural injections with autologous conditioned serum for lumbar radicular compression . . Cordelia Becker . . Spine 2007
    1. RESULTS – – Autologous conditioned serum injection for lumbar radicular compression showed significant decrease in pain and decreased disability (and thusly superior to steroid injections from weeks 12 – – to 22 weeks).

 

 

 

Read More

What Is Platelet Rich Plasma Treatment?

Benefits of Platelet Rich Plasma Therapy

 

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