700223?1318169294
Michael L Gross, MD  
Male, 57
Hackensack,Westwood, NJ

Specialties: orthopedic surgery, sports medicine

Interests: Orthopedics, Knee and Shoulder Arthroscopy
Active Orthopedics & Sports Medicine
201-343-2277
Hackensack, NJ
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Ask the Sports Doctor:  Platelet Rich Plasma

Jul 16, 2009 - 17 comments
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prp

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Platelet Rich Plasma

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Michael Gross

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orthopedic

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sports medicine

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Ask Dr. Gross



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.
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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



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by tallycane, Aug 01, 2009
How soon after the first treatment can you start some exercising?  I have tennis elbow (for 7 months) and have tried every other conservative treatment.  Can I continue to work out with weights in the gym after the first treatment while it is healing?

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by Michael L Gross, MDBlank, Aug 02, 2009
We usually recommend light activity for several weeks.  Usually stretching, either in a formal PT program or on your own, for the first three weeks

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by Darrell475, Aug 05, 2009
I have a small partial achilles tear. I was active running up to 16 miles at a time just before being diagnosed via ultrasound so I know it isn't major. I'm currently in a camwalker and softcast for 6 weeks. I want to avoid muscle loss and fitness loss if I don't have to.

I have a few questions
1. What is the cost associated with the PRP procedure?
2. Is it covered by insurance I have a 15% BCBS copay.
3. Do I need to follow conservative treatment for sometime before insurance will pay? if so how long? Thanks

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by mel0023, Sep 17, 2009
I have read alot about use of PRP for ankle sprains ( soft tissue injuries), how about for an ankle injury that won't heal completely, and an MRI showed bone necrosis ( moderate level) in ankle. Would injection help bone necrosis in the ankle? I have set one up for next week. Thanks. Mel

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by fyorgen, Oct 06, 2009
I injured my hamstring waterskiing about 5 weeks ago.  I went to an urgent care the day it happened but never returned to the doctor.  I could not walk on my leg for about 4 days and the leg was bruised from my glute down below my knee for about 3 weeks.  I started stretching and trying some rehab about 5 days after the injury but the strength in the hamstring seems to be slow in coming back.  How long should I expect to have to rehab?

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by tacster, Feb 16, 2010
I am 15 and i am very active in sports i am an all star cheerleader, high school cheerleader, soccer player and softball player. I have been having knee pain for about 4 months now and my doctor told me i have patellofemoral syndrome and a bad case of patellar tendonitis, so he told me to go to physical therapy to build my thigh muscles . I just went back the other day for my follow up because my knee pain has gotten worse and he thinks i have damaged cartilage in my knee and if i do he said i need surgery.
So if i do have to have surgery how long is the recovery and will i have to wear knee braces if i play these sports from now on?



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by derekb137, May 24, 2010
i am 33 i play ice hockey very regularly. i strained my pubis symphasis about a yr ago. ive been on indicin 75mg a day for about nine months now. im very worried that when i try to stop the indicin the pain i get in the pubic area increases. its hard to play hockey but it is in no comparison to the pain i have when i try to run. this injury is inhibiting alot of my life. would PRP be something that could be right for me? thank you in advance for your direction.


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by Michael L Gross, MDBlank, May 27, 2010
I think it might be worth a try.  Also consider the possibility that this may be a sports hernia.

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by kapoors, Nov 19, 2010
Hi,

I've been weight training for over 8 - 10 years now (on and off) & have a very good built (not very heavy though), i weight around 148 lbs & i am 5"7'. For the last 3 - 4 months i got involved in a very intense work out regime on the behest of my trainer as a consequence i've injured myself. My ortho has diagonosed the injury as bicipital tendinitis and has prescribed a medicine called "Disperzyme" which he says would help in repairing the soft tissues. He's asked me to take this for 15 days (twice a day) & said that if i do not get relief then he might have to inject a steroid which would permanentely settle thie down. I only feel the pain when I am performing those exercises where the biceps are involved but the pain is tolerable.

I wanted to find out that if i take complete rest for say around 4 weeks, would this settle down. Also, if "disperzyme" has any side effects & would there be any side effects if i had to go for the medical steroid he's suggested.

He said that i shouldn't take rest & should instead carry on with my normal work out but with relatively lighter weights and no biceps work out at all. He's also adviced me to get physiotherapy (ultrasound) done for atleast 2 weeks & to take heat therapy at home for 10 minutes thrice a day.

Looking forward for some advice!

Thanks

Sumit




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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 Gemprin, Apr 11, 2011
Hi,

Could you please tell me the success rate, if there is any for using PRP for sports hernia's? Iv'e been battling one for years, and trying everything I can to delay surgery.

Thank you!

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by Michael L Gross, MDBlank, Apr 13, 2011
I am not aware that data exists. My gut felling is that PRP could be used as am adjunct to a surgical repair, to serve as a cellular matrix to enhace healing. I dont think it would be useful instead of surgery

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by oats24716, Jun 21, 2011
I had a hip arthroscopy and debridement on my left hip in November 2010 to address a Stage 4 labral tear.  I have not been pain free with full range of motion, and I am not walking great due to the discomfort.  I do have some cartilage left in the joint but there are bone on bone sections.  I am an active 50 year old female with a 10 and 13 year old and would like to find a solution other than hip replacement at this point in my life.  Could I be a candidate for PRP to regrow cartilage in my hip joint?

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by sloar, Oct 13, 2011
i am a 40 year old triathlete that has osteitis pubis and can no longer run. i went 5 months with no running and was feeling great. so i decided to try and run after 50 feet the pain came back like i never took any time off. is there something i can do to treat this so i can go running again. thanks

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by Rossaroo, Dec 21, 2012
Hi Dr Gross

I have been having some issues with my left shoulder and have withdrawn from pushing exercises.  What course of action must occur before I would be eligible for prp injection.  I have United Healthcare.
Thanks,
Ross Welch

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by vish84, Jun 26, 2013
Hi Dr Gross

Lately I have been experiencing mid back pain on my right side in the T10-T12 area. I have been visiting a chiropractor and they figured out through my X-ray that I have a slight curvature (at the max 10 degrees) in my spine. They also said I have a shorter leg and one of my hips is slightly bent.I believe this is functional scoliosis. I used to lift a lot of heavy weights earlier. this believe this might have cause muscle imbalance and caused the spine to bent towards one side. My chiropractor says this curvature cannot be corrected but the pain may go away with stretches. I did some reading online and I found out functional scoliosis can be corrected. Is this true?

I want to go back to my bodybuilding routine but I cannot due to the back pain. I feel I have lost my motivation and
my confidence. Can you please help? :(

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by Nikki_smith, Jun 04, 2014
I am a gymnast and six weeks ago I frayed my ulnar collateral ligament and fractured my ulna. Do you think that it is safe to swim? It is summer right now and I really want to go swimming with my friends but my mom is scared that I'm going to hurt myself even more.

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