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Ask the Sports Doctor:  Platelet Rich Plasma (PRP)

Jul 15, 2009 - 5 comments
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orthopedic

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sports medicine

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Michael Gross

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prp

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Platelet Rich Plasma



Ask the Sports Doctor…
Dr. Michael Gross

I have heard a lot about a new injection technique with platelets for all sorts of orthopedic injuries.  What’s this about?

In Europe, and more recently in the United States, there has been an increasing use of patient’s own blood products to stimulate healing in a variety of settings.  PRP injections got a big publicity boost when two of the Pittsburgh Steelers’ stars, Hines Ward and Troy Palamalu, were treated with PRP before they returned from injuries to win the Super Bowl. Experts agree that PRP injections may be the key to treating a variey of stubborn injuries such as tennis elbow, tendonitis in a variety of locations, and plantar fasciitis. Presently, we have learned more about the role of growth factors in the healing process.  There is a growing enthusiasm for the use of concentrated platelets, which contain dense concentrations of growth factors to stimulate recovery for non-healing injuries.  This preparation of highly concentrated platelets is known as platelet rich plasma, and is commonly referred to as PRP. Below are the most common questions  I am asked regarding PRP treatment:

1.  What is PRP?  
     PRP is platelet rich plasma, sometimes also known as autologous blood concentrate.  Platelets are a special type of blood cell that are blood clotting and injury healing.  Exciting research demonstrates that when a concentrated platelet solution, known as PRP, in injected into an injury it can stimulate healing.

2.  Why does PRP work?
    Human platelets are extremely rich in important protein products, connective tissue growth factors.  Injecting these growth factors into damaged ligaments, tendons, and other soft tissues stimulates the natural repair process. The key to obtaining benefit from injecting these natural healing proteins is that the platelets must be concentrated.   In other words, by delivering a high concentration of platelets into a soft tissue injury, PRP recreates and stimulates the body’s natural healing process.

3.  What conditions can benefit from treatment with PRP?
    PRP treatment works best for chronic ligament and tendon sprains or strains that have not recovered with other conservative treatment.  These injuries include:
• Rotator cuff injuries
• Tennis elbow
• Golfer’s elbow
• Hamstring injuries
• Knee ligament sprains
• Patella tendonitis
• Ankle sprains
• Achilles tendonitis and partial tears
• Plantar fasciitis


4.  How is PRP done?
    In the office, one syringe of blood is drawn from the patient and placed in a special centrifuge where it is spun at high speed.  By doing this, the platelets are separated from the red blood cells and other blood products.  In addition, they are highly concentrated.  The injured area is anesthetized and then injected with this high concentration of platelets.  By injecting concentrated platelets and their growth factor directly into an injured area, the bodies own healing and regeneration processes are stimulated.

5.  How many injections are needed?
    Many patients respond after the first treatment.  A follow up appointment is scheduled six to eight weeks after the injection to evaluate the patient’s progress.  In some patients, up to three sessions are necessary.

6.  Do PRP injections hurt?
    The injured area is first anesthetized with long and short acting medications, so the actual injections are only slightly uncomfortable.  Once the numbness wears off, there may be some mild pain for several days.  Patients are instructed to avoid NSAID’s such as Advil, Motrin, Aleve, Celebrex and others, since they will neutralize the healing response that is stimulated by the PRP.  Tylenol is OK.  

7.  Are there risks associated with PRP?
    Of course, any time there is an injection, there are risks of infection, bleeding, or even nerve damage.  However, all of these are extremely rare.  Since we are injecting the patients own blood back into the injury, the risks of any allergy or sensitivity don’t exist.

8.  What is the success rate for PRP injections?
    Most recent studies suggest a success a success rate of 80 – 85%.  Some patients experience partial improvement, and many patients have complete relief.  Since PRP stimulates healing and is not a “cover up”, results are generally permanent.  

In summary, PRP provides now provides a promising alternative to surgical treatment for a variety of injuries and chronic conditions.  It is safe, easy to perform and promotes a natural healing response for patients.

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Dr. Michael Gross is the founder and director of Active Orthopedic and Sports Medicine.  He is the section chief of sports medicine and the orthopedic director of the Center for Sports Medicine at Hackensack University Medical Center.  Dr. Gross has written numerous articles and book chapters on sports injuries. He has taken care of some of Bergen County’s finest athletes, from weekend warriors to professional athletes. Dr Gross can be reached by e-mail at: ***@****
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Dr. Michael Gross is MedHelp's expert in the field of Orthopedic and Sports Medicine.  Dr. Gross is available daily to answer your personal questions in MedHelp's Orthopedic & Sports Medicine Forum:  http://www.medhelp.org/forums/Orthopedic-Sports-Medicine/show/317



Comments
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by sjdunnstl, Dec 21, 2009
  Is this available in St. Louis, MO?  If so, where?

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by hylndrsmistress, Oct 27, 2010
st peters bone and joint. Dr. Frisella

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by JohnO123456, Feb 07, 2011
Dr. --- I am going for PRP for tennis elbow. They do not use any imaging such as fluoroscopy to guide the needle. He does it “by feel”? He also does not use any numbing agent. All that I have read on PRP is that there should be fluoroscopy and local anesthetic. Would you please let me know what your thoughts are on “injection by feel”……………….


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by Michael L Gross, MDBlank, Feb 07, 2011
most orthopedists are confident the can find the right spot without fluoroscopic guidance. however, some studies have shown otherwise. Flouroscopy doesn't hurt, and can only help. As far as not using local anesthetic, i disagree with that very strongly.  In my off ice we use a combination of both long acting and short acting anesthetics for all PRP injections.  Initially, we didn't do so, I can tell you, the difference is dramatic!

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by carladds, Jun 17, 2012
Can PRP be done on a patient with high platelets due to essntial thrombocytosis who must take high doses of aspirin daily?  

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